Kerry Alice Chrysalis Bursley, LPC
Individual provider Active NPI Professional Counselor · Raymore, MO
NPI 1780192856 · NPPES record last updated Nov 21, 2023
Key facts
- NPI
- 1780192856
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 2017042943 (MO)
- Practice address
- 501 N Sunset LN
Raymore, MO 64083-9402 - Phone
- (844) 853-8937
- NPI assigned
- Jan 11, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Compass Health Inc
Practice addresses (Care Compare)
1198 Martin St
Cuba, MO 65453-1656
Phone (844) 853-8937
1448 E 10TH St
Rolla, MO 65401-3648
Phone (844) 853-8937
1450 E 10TH St
Rolla, MO 65401-3648
Phone (888) 403-1071
1800 Community
Clinton, MO 64735-8804
Phone (888) 403-1071
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231122000655 | MO | Practitioner - Mental Health Counselor | 1456709971 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Compass Health, Inc | Current |
Accepting new patients | |
| Compass Health, Inc | Current |
Accepting new patients |
Locations
1800 Community
#B
Clinton, MO 64735
1800 Community
Clinton, MO 64735
Phone (660) 885-8131
201 N Garth Ave
Columbia, MO 65203
Phone (573) 449-3953
501 N Sunset Ln
Raymore, MO 64083
Phone (448) 538-9378
1010 Remington Plz
Raymore, MO 64083
Phone (816) 318-4430
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2017042943 | MO | Yes |
Addresses
Primary practice location
501 N Sunset LN
Raymore, MO 64083-9402
Mailing address
1800 Community
Clinton, MO 64735-8804
Phone (660) 885-8131
Other names
- Kerry Alice Earthsoul
Other providers in Raymore, MO
- Bryan Huff O.D., P.C
- Kember Lee Ann Buhman
- Lisa Elaine Burdick
- Burleson Orthodontics and Pediatric Dentistry, LLC
- Janet Lynn Burns
- Deanna Lee Campbell
- Cantrell Chiropractic
- Christina R. Cantrell
- Shannon Cantrell
- Donna R. Carroll
All providers in Raymore, MO · Professional Counselor in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.