Healthcare Provider Details

I. General information

NPI: 1871418384
Provider Name (Legal Business Name): CRYSTAL CLEAR HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 W CORONA AVE STE 209
PUEBLO CO
81004-1210
US

IV. Provider business mailing address

842 S WOLCOTT DR
PUEBLO WEST CO
81007-1736
US

V. Phone/Fax

Practice location:
  • Phone: 719-334-6333
  • Fax:
Mailing address:
  • Phone: 719-334-6333
  • 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: ABIGAIL BENSKO
Title or Position: LPC
Credential: LPC
Phone: 719-334-6333