Provider Demographics
NPI:1720609118
Name:COLON, CRYSTAL M (LMFT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:COLON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 EGYPT RD
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-2405
Mailing Address - Country:US
Mailing Address - Phone:860-874-7756
Mailing Address - Fax:
Practice Address - Street 1:99 STAFFORD RD STE B-1
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-2834
Practice Address - Country:US
Practice Address - Phone:860-874-7756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2671106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist