Provider Demographics
NPI:1740638998
Name:JULIAN-FRALISH, CHRISTOPHER JAMES (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:JULIAN-FRALISH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5376 TOMAH DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6968
Mailing Address - Country:US
Mailing Address - Phone:719-999-5073
Mailing Address - Fax:719-344-9250
Practice Address - Street 1:5376 TOMAH DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6968
Practice Address - Country:US
Practice Address - Phone:719-999-5073
Practice Address - Fax:719-344-9250
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-28
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099253161041C0700X, 1041C0700X
IL149.0124471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCSW.09925316OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES - DIVISION OF PROFESSIONS AND OCCUPAT