Healthcare Provider Details

I. General information

NPI: 1780182717
Provider Name (Legal Business Name): CRYSTAL MONEL WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2229 SAN CLEMENTE DR
BATON ROUGE LA
70815-1271
US

IV. Provider business mailing address

2229 SAN CLEMENTE DR
BATON ROUGE LA
70815-1271
US

V. Phone/Fax

Practice location:
  • Phone: 225-384-0231
  • Fax: 225-460-8719
Mailing address:
  • Phone: 225-384-0231
  • Fax: 225-460-8719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC8754
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC8754
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberPLC8754
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: