Healthcare Provider Details

I. General information

NPI: 1477397164
Provider Name (Legal Business Name): KIMBERLY CHRYSTAL CROMER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3239 INDEPENDENCE RD
CANON CITY CO
81212-9380
US

IV. Provider business mailing address

927 OAK AVE
CANON CITY CO
81212-2153
US

V. Phone/Fax

Practice location:
  • Phone: 719-275-7650
  • Fax:
Mailing address:
  • Phone: 719-684-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002966
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009926011
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: