Provider Demographics
NPI:1033734108
Name:KREUZBERGER, KELLY (LAC, LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KREUZBERGER
Suffix:
Gender:F
Credentials:LAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MANITOU SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80829-2742
Mailing Address - Country:US
Mailing Address - Phone:720-593-0887
Mailing Address - Fax:
Practice Address - Street 1:6170 LEHMAN DR STE 105
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3443
Practice Address - Country:US
Practice Address - Phone:720-593-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-14
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001987101YA0400X, 101YA0400X
COLPC.0018313101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional