MEDICARE: KRYSTA MARIE PARKER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	09929198	CO
2	1041C0700X	Clinical Social Worker	12278178-3501	UT

General Provider Information

NPI Number	:	1235822420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTA MARIE PARKER LCSW

Provider Business Mailing Address
First Line	:	6838 BACKCOUNTRY LOOP
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80927-4204
Country	:	US
Telephone Number	:	702-683-0999
Fax Number	:

Provider Business Practice Location Address
First Line	:	6838 BACKCOUNTRY LOOP
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80927-4204
Country	:	US
Telephone Number	:	702-683-0999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	03/05/2025

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