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General NPI Number Information
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NPI Number | 1609484062
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Entity Type | Individual
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Provider Name | CRISTON A MENZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 408 N MAIN ST STE F
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City | ROCKY FORD
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State | CO
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Zip | 81067-1256
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Country | US
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Telephone | 719-423-8834
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Fax | 719-316-2753
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Provider Business Mailing Address
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Address Line | 1100 HOPKINS AVE
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City | ROCKY FORD
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State | CO
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Zip | 81067-2421
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Country | US
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Telephone | 719-696-0910
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Fax | 719-316-2753
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0009923059
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW.09928454
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License Number State | CO
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