Healthcare Provider Details

I. General information

NPI: 1861122855
Provider Name (Legal Business Name): CRYSTAL LEON LCSW 96139
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST KINGS WAY
AVENAL CA
93204-3521
US

IV. Provider business mailing address

961 CHIANTI CIR
COALINGA CA
93210-3521
US

V. Phone/Fax

Practice location:
  • Phone: 559-386-0587
  • Fax:
Mailing address:
  • Phone: 559-978-5137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: