| Kelly Kreuzberger Llc | |
|
6170 Lehman Dr Suite 105- 2 Colorado Springs CO 80918-3436 | |
| (720) 593-0887 | |
| Not Available |
| Full Name | Kelly Kreuzberger Llc |
|---|---|
| Speciality | Counselor |
| Location | 6170 Lehman Dr, Colorado Springs, Colorado |
| Authorized Official Name and Position | Kelly Kreuzberger (OWNER) |
| Authorized Official Contact | 7192316427 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly Kreuzberger Llc 16 Mountain View Rd Manitou Springs CO 80829-2742 Ph: (719) 231-6427 | Kelly Kreuzberger Llc 6170 Lehman Dr Suite 105- 2 Colorado Springs CO 80918-3436 Ph: (720) 593-0887 |
| NPI Number | 1023729761 |
|---|---|
| Provider Enumeration Date | 12/13/2022 |
| Last Update Date | 09/04/2023 |
| Certification Date | 09/04/2023 |
| Medicare PECOS PAC ID | 9436592466 |
|---|---|
| Medicare Enrollment ID | O20240207001187 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023729761 | NPI | - | NPPES |
| 9000212606 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kelly Rae Kreuzberger |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033734108 PECOS PAC ID: 0345683371 Enrollment ID: I20240207004038 |
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