Provider Demographics
NPI:1992535140
Name:MAIRS, KRYSTEL
Entity type:Individual
Prefix:
First Name:KRYSTEL
Middle Name:
Last Name:MAIRS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2403
Mailing Address - Country:US
Mailing Address - Phone:210-854-7643
Mailing Address - Fax:
Practice Address - Street 1:2500 30TH ST STE 303
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1239
Practice Address - Country:US
Practice Address - Phone:210-854-7643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC105323101Y00000X
COLPC21435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor