Provider Demographics
NPI:1508300344
Name:ROSALINDA PENA
Entity Type:Organization
Organization Name:ROSALINDA PENA
Other - Org Name:CRYSTAL CLEAR CHRISTIAN COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-778-9208
Mailing Address - Street 1:2612 IVYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3642
Mailing Address - Country:US
Mailing Address - Phone:719-778-9208
Mailing Address - Fax:
Practice Address - Street 1:2612 IVYWOOD LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3642
Practice Address - Country:US
Practice Address - Phone:719-778-9208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty