Healthcare Provider Details

I. General information

NPI: 1619429875
Provider Name (Legal Business Name): CRYSTAL SHEARD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E PECOS RD
GILBERT AZ
85295-3200
US

IV. Provider business mailing address

4539 N 22ND ST STE R
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 480-330-5042
  • Fax:
Mailing address:
  • Phone: 480-330-5042
  • Fax: 480-302-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-19781
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: