Healthcare Provider Details

I. General information

NPI: 1629760806
Provider Name (Legal Business Name): CRYSTAL YEAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29995 TECHNOLOGY DR
MURRIETA CA
92563-2632
US

IV. Provider business mailing address

29995 TECHNOLOGY DR
MURRIETA CA
92563-2632
US

V. Phone/Fax

Practice location:
  • Phone: 951-221-3740
  • Fax:
Mailing address:
  • Phone: 951-221-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number103694
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number103694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: