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General NPI Number Information
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NPI Number | 1669071213
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Entity Type | Individual
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Provider Name | CRYSTAL REANEE KISSELBURGH MA, LAC, LPCC
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Gender | Female
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 2956 NORTH AVE STE 1
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City | GRAND JUNCTION
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State | CO
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Zip | 81504-3919
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Country | US
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Telephone | 970-208-1103
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Fax |
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Provider Business Mailing Address
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Address Line | 649 BROKEN SPOKE RD
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City | GRAND JUNCTION
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State | CO
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Zip | 81504-6981
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Country | US
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Telephone | 970-779-7824
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC.0026958
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACD.0001546
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License Number State | CO
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