Healthcare Provider Details

I. General information

NPI: 1275499253
Provider Name (Legal Business Name): CRISALIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 CENTER PARK DRIVE
COLORADO SPRINGS CO
80916-4505
US

IV. Provider business mailing address

4180 CENTER PARK DRIVE
COLORADO SPRINGS CO
80916-4505
US

V. Phone/Fax

Practice location:
  • Phone: 719-698-8036
  • Fax:
Mailing address:
  • Phone: 719-698-8036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: GLORY MCDANIEL
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC, LAC
Phone: 303-519-9218