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General NPI Number Information
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NPI Number | 1598634719
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Entity Type | Organization
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Legal Business Name | CRISALIDA, INC
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 4180 CENTER PARK DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80916-4505
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Country | US
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Telephone | 719-698-8036
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Fax |
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Provider Business Mailing Address
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Address Line | 4180 CENTER PARK DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80916-4505
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Country | US
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Telephone | 719-698-8036
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GLORY MCDANIEL
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Credential | LPC, LAC
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Telephone | 303-519-9218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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