Healthcare Provider Details

I. General information

NPI: 1043123334
Provider Name (Legal Business Name): CRYSTAL NELSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 OREGON ST STE 216
REDDING CA
96001-1757
US

IV. Provider business mailing address

3293 LEONARD ST
REDDING CA
96002-2351
US

V. Phone/Fax

Practice location:
  • Phone: 530-206-5560
  • Fax:
Mailing address:
  • Phone: 530-440-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW140211
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW140211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: