Provider Demographics
NPI:1396325650
Name:KRALA, AGATA (LPCC)
Entity type:Individual
Prefix:
First Name:AGATA
Middle Name:
Last Name:KRALA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4588 GUNBARREL DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-1033
Mailing Address - Country:US
Mailing Address - Phone:719-766-8136
Mailing Address - Fax:
Practice Address - Street 1:4588N GUNBARREL DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80925-1033
Practice Address - Country:US
Practice Address - Phone:719-766-8136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01-200-0975OtherDRIVER LICENSE