MEDICARE: CRYSTAL AHLES LCSW, LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0000500	CO
2	1041C0700X	Clinical Social Worker	CSW.09923914	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	107200	OTHER	CO	OBH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	840575023	OTHER	CO	TAX #
4	1083617344	OTHER	CO	NPI #

General Provider Information

NPI Number	:	1528309929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL AHLES LCSW, LAC

Provider Business Mailing Address
First Line	:	121 ACOMA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80223-1429
Country	:	US
Telephone Number	:	303-722-5746
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 ACOMA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80223-1429
Country	:	US
Telephone Number	:	303-722-5746
Fax Number	:

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

Provider Enumeration Date	:	03/09/2013
Last Update Date	:	11/06/2020

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