Healthcare Provider Details

I. General information

NPI: 1255079091
Provider Name (Legal Business Name): CRYSTAL NUNN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL BURRISS LPCC

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 RUSSELL RD STE 93
COLUMBIA KY
42728-1054
US

IV. Provider business mailing address

933 RUSSELL RD STE 93
COLUMBIA KY
42728-1054
US

V. Phone/Fax

Practice location:
  • Phone: 270-384-1736
  • Fax: 270-384-1734
Mailing address:
  • Phone: 270-384-1736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number251049
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number278265
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: