Provider Demographics
NPI:1881971984
Name:LARDY, CRYSTAL BLISS (MA, NCC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:BLISS
Last Name:LARDY
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7166 COUNTY ROAD 154
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-9455
Mailing Address - Country:US
Mailing Address - Phone:719-276-5488
Mailing Address - Fax:
Practice Address - Street 1:7166 COUNTY ROAD 154
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9455
Practice Address - Country:US
Practice Address - Phone:719-626-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO0011777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health