MEDICARE: MRS. KRISTY L STANSELL LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC0011707	CO
2	101YP2500X	Professional Counselor	LPC0011707	CO

General Provider Information

NPI Number	:	1154063725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTY L STANSELL LPC

Provider Business Mailing Address
First Line	:	2860 S CIRCLE DR STE 400
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4184
Country	:	US
Telephone Number	:	719-540-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1369 FOREST LN
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-3528
Country	:	US
Telephone Number	:	719-269-4250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2022
Last Update Date	:	06/16/2025

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