Provider Demographics
NPI:1487001525
Name:GALLEGO, KRISTI ALISSSA (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:ALISSSA
Last Name:GALLEGO
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 BECKY DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2205
Mailing Address - Country:US
Mailing Address - Phone:719-323-9096
Mailing Address - Fax:
Practice Address - Street 1:1170 BECKY DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-2205
Practice Address - Country:US
Practice Address - Phone:719-323-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012988101YM0800X
CO114950101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool