Healthcare Provider Details

I. General information

NPI: 1649187352
Provider Name (Legal Business Name): CRYSTAL HEART HEALING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CLUB CENTRE CT
EDWARDSVILLE IL
62025-3519
US

IV. Provider business mailing address

2216 S COLLEGE ST
SPRINGFIELD IL
62704-4739
US

V. Phone/Fax

Practice location:
  • Phone: 217-836-7655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KELLIE BRAND
Title or Position: OWNER/ THERAPIST
Credential: LCPC
Phone: 217-836-7655