Provider Demographics
NPI:1528309929
Name:AHLES, CRYSTAL (LCSW, LAC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:AHLES
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:COLUSSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 ACOMA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-1429
Mailing Address - Country:US
Mailing Address - Phone:303-722-5746
Mailing Address - Fax:
Practice Address - Street 1:121 ACOMA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-1429
Practice Address - Country:US
Practice Address - Phone:303-722-5746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-09
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000500101YA0400X
COCSW.099239141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO107200OtherOBH
CO35975245Medicaid
CO840575023OtherTAX #
CO1083617344OtherNPI #