Healthcare Provider Details

I. General information

NPI: 1053047449
Provider Name (Legal Business Name): KRISTEL MICHELE PHELPS MA, LPC, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 MONROE DR APT B
BOULDER CO
80303-2124
US

IV. Provider business mailing address

1650 38TH ST STE 100E
BOULDER CO
80301-2624
US

V. Phone/Fax

Practice location:
  • Phone: 719-502-0329
  • Fax:
Mailing address:
  • Phone: 720-644-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberATR.20-436
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0018720
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: