Provider Demographics
NPI:1255079091
Name:NUNN, CRYSTAL (LPCC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:NUNN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:BURRISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:933 RUSSELL RD STE 93
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1054
Mailing Address - Country:US
Mailing Address - Phone:270-384-1736
Mailing Address - Fax:
Practice Address - Street 1:933 RUSSELL RD STE 93
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1054
Practice Address - Country:US
Practice Address - Phone:270-384-1736
Practice Address - Fax:270-384-1734
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY278265101YP2500X
KY251049101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100293880Medicaid