MEDICARE: KRYSTAL BELL 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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	101639	CA
3	1041C0700X	Clinical Social Worker	9922107	CO
4	1041C0700X	Clinical Social Worker	09925650	CO

General Provider Information

NPI Number	:	1497133912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL BELL LCSW

Provider Business Mailing Address
First Line	:	1364 BARKELEY AVE BLDG 1150
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4161
Country	:	US
Telephone Number	:	719-526-0175
Fax Number	:

Provider Business Practice Location Address
First Line	:	1364 BARKELEY AVE BLDG 1150
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4161
Country	:	US
Telephone Number	:	719-526-0175
Fax Number	:

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

Provider Enumeration Date	:	05/16/2015
Last Update Date	:	12/10/2025

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