Provider Demographics
NPI:1902102494
Name:MAESTAS, KYMBERLY (LPC, CAS, NCC, CCTP,)
Entity type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:
Last Name:MAESTAS
Suffix:
Gender:F
Credentials:LPC, CAS, NCC, CCTP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2404
Mailing Address - Country:US
Mailing Address - Phone:970-549-2849
Mailing Address - Fax:970-549-1400
Practice Address - Street 1:300 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2404
Practice Address - Country:US
Practice Address - Phone:970-549-2849
Practice Address - Fax:970-549-1400
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4392101YP2500X
CO6175101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)