Provider Demographics
NPI:1750928255
Name:COLLASO, CRISTINA D (RP, CAC I, MRT ATP)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:D
Last Name:COLLASO
Suffix:
Gender:F
Credentials:RP, CAC I, MRT ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 S DEPEW ST APT 1
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-3748
Mailing Address - Country:US
Mailing Address - Phone:720-907-5242
Mailing Address - Fax:
Practice Address - Street 1:10699 MELODY DR STE 2
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4131
Practice Address - Country:US
Practice Address - Phone:303-252-4179
Practice Address - Fax:303-252-4186
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0108389101Y00000X
COACA.0007581101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1740608959Medicaid