Provider Demographics
NPI:1679874846
Name:SEPULVEDA, CHRISTINA LOUISE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:LOUISE
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12703 PINE VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4010
Mailing Address - Country:US
Mailing Address - Phone:719-332-6011
Mailing Address - Fax:
Practice Address - Street 1:5376 TOMAH DR STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6967
Practice Address - Country:US
Practice Address - Phone:719-332-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5859101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional