Provider Demographics
NPI:1750661799
Name:CROSWAITE BRINDLE, KHARA KAY (MA, LPC, ACS)
Entity Type:Individual
Prefix:
First Name:KHARA
Middle Name:KAY
Last Name:CROSWAITE BRINDLE
Suffix:
Gender:F
Credentials:MA, LPC, ACS
Other - Prefix:
Other - First Name:KHARA
Other - Middle Name:KAY
Other - Last Name:CROSWAITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, ACS
Mailing Address - Street 1:7700 E ACADEMY BLVD
Mailing Address - Street 2:UNIT 305
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7167
Mailing Address - Country:US
Mailing Address - Phone:720-245-7390
Mailing Address - Fax:
Practice Address - Street 1:495 UINTA WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7110
Practice Address - Country:US
Practice Address - Phone:720-245-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13305034Medicaid