Provider Demographics
NPI:1528859196
Name:GESTAL, CHRISTIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:GESTAL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 CANYON BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5652
Mailing Address - Country:US
Mailing Address - Phone:720-304-2183
Mailing Address - Fax:
Practice Address - Street 1:2355 CANYON BLVD STE 106
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5652
Practice Address - Country:US
Practice Address - Phone:720-304-2183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health