Healthcare Provider Details

I. General information

NPI: 1295345460
Provider Name (Legal Business Name): CRISTINA CAMPOS-KRUMHOLZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10679 MCGAHAN DR
FOUNTAIN CO
80817-6312
US

IV. Provider business mailing address

10679 MCGAHAN DR
FOUNTAIN CO
80817-6312
US

V. Phone/Fax

Practice location:
  • Phone: 719-252-0709
  • Fax:
Mailing address:
  • Phone: 719-252-0709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0023383
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: