Provider Demographics
NPI:1760884431
Name:KELLY, CHRISTINA
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 33RD ST
Mailing Address - Street 2:UNIT 201
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2364
Mailing Address - Country:US
Mailing Address - Phone:719-660-5681
Mailing Address - Fax:
Practice Address - Street 1:4500 CHERRY CREEK DRIVE SOUTH
Practice Address - Street 2:STE. 940
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246
Practice Address - Country:US
Practice Address - Phone:303-322-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health