Healthcare Provider Details

I. General information

NPI: 1699369033
Provider Name (Legal Business Name): KHAIYA CRYSTAL CROOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 HARRISON ST
SAN FRANCISCO CA
94107-1235
US

IV. Provider business mailing address

982 MISSION ST
SAN FRANCISCO CA
94103-2911
US

V. Phone/Fax

Practice location:
  • Phone: 415-836-1700
  • Fax: 415-836-1737
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: