Healthcare Provider Details

I. General information

NPI: 1306326426
Provider Name (Legal Business Name): CRYSTAL LYNN ANTOLIN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10265 ROCKINGHAM DR STE 100-4286
SACRAMENTO CA
95827-2523
US

IV. Provider business mailing address

10265 ROCKINGHAM DR STE 100-4286
SACRAMENTO CA
95827-2523
US

V. Phone/Fax

Practice location:
  • Phone: 916-868-9266
  • Fax:
Mailing address:
  • Phone: 916-868-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number145035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: