Healthcare Provider Details

I. General information

NPI: 1841991353
Provider Name (Legal Business Name): CRISALIDA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 CENTER PARK DR
COLORADO SPRINGS CO
80916-4505
US

IV. Provider business mailing address

4180 CENTER PARK DR
COLORADO SPRINGS CO
80916-4505
US

V. Phone/Fax

Practice location:
  • Phone: 719-418-9705
  • Fax:
Mailing address:
  • Phone: 720-446-8701
  • 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 Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: GLORY MCDANIEL
Title or Position: FOUNDER/EXECUTIVE DIRECTOR
Credential: LPC, LAC, MFTC
Phone: 719-698-8036