Provider Demographics
NPI:1912039652
Name:JOHNSON, KRISTA (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 W COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3840
Mailing Address - Country:US
Mailing Address - Phone:719-632-2663
Mailing Address - Fax:719-213-2552
Practice Address - Street 1:2021 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3840
Practice Address - Country:US
Practice Address - Phone:719-632-2663
Practice Address - Fax:719-213-2552
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional