NPIMap

Organization Active NPI

Crystal Creek Counseling , PC Inc.

  • Clinical Social Worker
  • Longmont, CO
National Provider Identifier
1518741966
Registry record updated Aug 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
CRYSTAL CREEK COUNSELING , PC INC.
Practice address
500 Coffman St Ste 210
Longmont, CO 80501-5445
Phone
(719) 686-6703
NPI assigned
Aug 24, 2023
Last updated
Aug 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jerilyn L YinglingNPI 1114343928
Title
Owner
Phone
(719) 686-6703

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

500 Coffman St Ste 210
Longmont, CO 80501-5445

Mailing address

PO Box 94
Green Mountain Falls, CO 80819-0094

National Provider Directory

National Provider Directory
Tax ID family
Crystal Creek Counseling PC Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692835200000",
    "number": "1518741966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94",
            "city": "GREEN MOUNTAIN FALLS",
            "state": "CO",
            "postal_code": "808190094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 COFFMAN ST STE 210",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805015445",
            "telephone_number": "719-686-6703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL CREEK COUNSELING , PC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-24",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A",
        "authorized_official_last_name": "YINGLING",
        "authorized_official_first_name": "JERILYN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-686-6703"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.