Provider Demographics
NPI:1992965693
Name:KRULL, KEITH (LPC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:KRULL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 S DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5822
Mailing Address - Country:US
Mailing Address - Phone:303-778-5774
Mailing Address - Fax:303-778-3701
Practice Address - Street 1:2465 S DOWNING ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5822
Practice Address - Country:US
Practice Address - Phone:303-778-5774
Practice Address - Fax:303-778-3701
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC904101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional