Healthcare Provider Details

I. General information

NPI: 1447903034
Provider Name (Legal Business Name): CRYSTAL SOTO MSW, CAS, SWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WEST 2ND STREET
PUEBLO CO
81003-1379
US

IV. Provider business mailing address

107 W 2ND ST
PUEBLO CO
81003-3223
US

V. Phone/Fax

Practice location:
  • Phone: 719-545-2746
  • Fax:
Mailing address:
  • Phone: 719-299-1830
  • Fax: 719-545-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberACA.0008048
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: