Healthcare Provider Details

I. General information

NPI: 1720829971
Provider Name (Legal Business Name): KRISTAL OTTO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 10/26/2026
Certification Date: 10/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 PAONIA PARK PL
COLORADO SPRINGS CO
80924-1201
US

IV. Provider business mailing address

9920 PAONIA PARK PL
COLORADO SPRINGS CO
80924-1201
US

V. Phone/Fax

Practice location:
  • Phone: 303-419-0730
  • Fax:
Mailing address:
  • Phone: 303-419-0730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23769
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2934
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: