Healthcare Provider Details

I. General information

NPI: 1568327153
Provider Name (Legal Business Name): KRYSTAL DICKERSON M.ED AND PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21900 CENTURION WAY
SANTA CLARITA CA
91350-1699
US

IV. Provider business mailing address

21380 CENTRE POINTE PKWY
SANTA CLARITA CA
91350-3050
US

V. Phone/Fax

Practice location:
  • Phone: 661-297-3900
  • Fax:
Mailing address:
  • Phone: 661-259-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: