Provider Demographics
NPI:1134770241
Name:PIPER, CRYSTAL DALE (MA, LPC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DALE
Last Name:PIPER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:DALE
Other - Last Name:BOMEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22003 E GRAND DR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4713
Mailing Address - Country:US
Mailing Address - Phone:303-506-8266
Mailing Address - Fax:
Practice Address - Street 1:22003 E GRAND DR
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-4713
Practice Address - Country:US
Practice Address - Phone:303-506-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0014930101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty