Provider Demographics
NPI:1447903034
Name:SOTO, CRYSTAL (MSW, CAS, SWC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:SOTO
Suffix:
Gender:
Credentials:MSW, CAS, SWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3223
Mailing Address - Country:US
Mailing Address - Phone:719-299-1830
Mailing Address - Fax:719-545-4100
Practice Address - Street 1:107 WEST 2ND STREET
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-1379
Practice Address - Country:US
Practice Address - Phone:719-545-2746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
COACA.0008048101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker