Provider Demographics
NPI:1730394941
Name:BRAY, KRISTA RACHELLE (LPC)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:RACHELLE
Last Name:BRAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:RACHELLE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1811 N. NEVADA AVE.
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-232-3091
Mailing Address - Fax:
Practice Address - Street 1:3225 TEMPLETON GAP RD. STE 106
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-232-3091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional