Healthcare Provider Details

I. General information

NPI: 1386991875
Provider Name (Legal Business Name): KRISTIN J. EXTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 BRIARGATE BLVD., SUITE 220
COLORADO SPRINGS CO
80920
US

IV. Provider business mailing address

1200 N. JAMES ST.
JACKSONVILLE AR
72076
US

V. Phone/Fax

Practice location:
  • Phone: 501-247-9702
  • Fax: 719-528-6553
Mailing address:
  • Phone: 501-247-9702
  • Fax: 501-982-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00992087
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: