Healthcare Provider Details

I. General information

NPI: 1306753769
Provider Name (Legal Business Name): SAFE SPACE CHILD AND FAMILY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 LEWIS AVE
LA JUNTA CO
81050-3024
US

IV. Provider business mailing address

10679 MCGAHAN DR
FOUNTAIN CO
80817-6312
US

V. Phone/Fax

Practice location:
  • Phone: 719-510-7672
  • Fax:
Mailing address:
  • Phone: 719-510-7672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CRISTINA CAMPOS-KRUMHOLZ
Title or Position: OWNER
Credential: LPC
Phone: 719-510-7672