Healthcare Provider Details

I. General information

NPI: 1194462887
Provider Name (Legal Business Name): CRYSTAL LYNN GWINN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5814 OLD PASCO RD
WESLEY CHAPEL FL
33544-4011
US

IV. Provider business mailing address

401 TUSCAN LN
OLDSMAR FL
34677-0137
US

V. Phone/Fax

Practice location:
  • Phone: 908-938-1577
  • Fax:
Mailing address:
  • Phone: 727-267-3291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-84930
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: