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NPI Code Detail

MEDICARE: CRYSTAL LISSUZZO BCBA

MEDICARE: CRYSTAL LISSUZZO BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Q00000XDevelopmental Therapist
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1861844755
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL LISSUZZO BCBA
Provider Business Mailing Address
First Line : 16538 N MAY AVE
Second Line :
City : EDMOND
State : OK
Zip : 73012-9007
Country : US
Telephone Number : 405-253-0071
Fax Number :
Provider Business Practice Location Address
First Line : 16538 N MAY AVE
Second Line :
City : EDMOND
State : OK
Zip : 73012-9007
Country : US
Telephone Number : 405-253-0071
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2016
Last Update Date : 08/18/2021

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Directions to “ CRYSTAL LISSUZZO BCBA” Practice Location

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