MEDICARE: AGATA KRALA 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01-200-0975	OTHER	CO	DRIVER LICENSE

General Provider Information

NPI Number	:	1396325650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGATA KRALA LPC

Provider Business Mailing Address
First Line	:	4588 GUNBARREL DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80925-1033
Country	:	US
Telephone Number	:	719-766-8136
Fax Number	:

Provider Business Practice Location Address
First Line	:	4588N GUNBARREL DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80925-1033
Country	:	US
Telephone Number	:	719-766-8136
Fax Number	:

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

Provider Enumeration Date	:	04/12/2021
Last Update Date	:	03/04/2026

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