Healthcare Provider Details

I. General information

NPI: 1053723916
Provider Name (Legal Business Name): CRYSTAL MARIE NUNLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 MUSTANG WAY
OCEANSIDE CA
92057-5611
US

IV. Provider business mailing address

1675 MUSTANG WAY
OCEANSIDE CA
92057-5611
US

V. Phone/Fax

Practice location:
  • Phone: 661-350-7010
  • Fax:
Mailing address:
  • Phone: 661-350-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW80813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: