Healthcare Provider Details

I. General information

NPI: 1558720086
Provider Name (Legal Business Name): KRISTA JUERLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 AMERICAS PKWY NE SUITE 200
ALBUQUERQUE NM
87110-8116
US

IV. Provider business mailing address

3969 E ARAPAHOE RD STE 210
CENTENNIAL CO
80122-2071
US

V. Phone/Fax

Practice location:
  • Phone: 186-627-3245
  • Fax:
Mailing address:
  • Phone: 720-213-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2023-0143
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: