MEDICARE: SAFE SPACE CHILD AND FAMILY THERAPY LLC

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

General Provider Information

NPI Number	:	1700721685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE SPACE CHILD AND FAMILY THERAPY LLC

Provider Business Mailing Address
First Line	:	10679 MCGAHAN DR
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-6312
Country	:	US
Telephone Number	:	719-252-0709
Fax Number	:

Provider Business Practice Location Address
First Line	:	10679 MCGAHAN DR
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-6312
Country	:	US
Telephone Number	:	719-252-0709
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CRISTINA CAMPOS-KRUMHOLZ
Credential	:	LPC
Telephone Number	:	719-252-0709

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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