Provider Demographics
NPI:1487113221
Name:CRYSTAL CREEK COUNSELING , PC INC.
Entity type:Organization
Organization Name:CRYSTAL CREEK COUNSELING , PC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERILYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:YINGLING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-686-6703
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:GREEN MOUNTAIN FALLS
Mailing Address - State:CO
Mailing Address - Zip Code:80819-0094
Mailing Address - Country:US
Mailing Address - Phone:719-686-6703
Mailing Address - Fax:719-325-8958
Practice Address - Street 1:400 W MIDLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-3199
Practice Address - Country:US
Practice Address - Phone:719-686-6703
Practice Address - Fax:719-325-8958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty