Crystal Reanee Kisselburgh, MA, LAC, LPCC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

ACD.0001546 Issued in CO

Practice address

2956 North Ave Ste 1
Grand Junction, CO 81504-3919

Phone

(970) 208-1103

NPI assigned

Oct 23, 2020

Last updated

Apr 20, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Medical Group LLCGroup PAC ID 1052612785, 109 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Community Hospital Hospital, Grand Junction, CO, CCN 060054

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Medical Group, LLC

  dba Internal Medicine Associates of the Grand Valley

  • Internal Medicine Physician
  • Grand Junction, CO
  • NPI 1043640634

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Community Medical Group, LLC

  dba CMG Specialty 5

  • Surgery Physician
  • Grand Junction, CO
  • NPI 1164997524
  NPD
• Community Medical Group, LLC

  dba Western Colorado Bone Health

  • Specialist
  • Grand Junction, CO
  • NPI 1720736937
  NPD
• Community Medical Group, LLC

  dba Grand Valley Behavioral Health

  • Specialist
  • Grand Junction, CO
  • NPI 1538713136
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Colorado West Healthcare System

  dba Community Hospital

  • General Acute Care Hospital
  • Grand Junction, CO
  • NPI 1497723407
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1669071213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "649 BROKEN SPOKE RD",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815046981",
            "telephone_number": "970-779-7824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2956 NORTH AVE STE 1",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815043919",
            "telephone_number": "970-208-1103"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1150 N 25th St Ste D",
            "address_purpose": "LOCATION",
            "city": "Grand Junction",
            "state": "CO",
            "postal_code": "815016561",
            "country_code": "US",
            "telephone_number": "970-779-7824",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KISSELBURGH",
        "first_name": "CRYSTAL",
        "middle_name": "REANEE",
        "credential": "MA, LAC, LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-23",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "LPC.0026958",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": "ACD.0001546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lewis J Kirkegaard, MD
• Elizabeth Jeanne Kirtley, ATC
• Kiser Counseling Inc.
• Kiser Counseling, Inc
• Christine L. Kisselburgh, M.A.E.
• Julie Kissner
• Pamela Jean Kistenmacher
• Kit W Haddow, DDS (Kit W Haddow)
• Ethan Kitchell
• Melissa Kitchell, CCC-SLP

• Addiction (Substance Use Disorder) Counselor in Grand Junction, CO
• Providers in Grand Junction, CO by specialty
• Addiction (Substance Use Disorder) Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.