Healthcare Provider Details

I. General information

NPI: 1851813711
Provider Name (Legal Business Name): CRYSTAL FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 W PINHOOK RD STE 201
LAFAYETTE LA
70508-3735
US

IV. Provider business mailing address

11104 ERINMOOR TRL
HASLET TX
76052-6180
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-0770
  • Fax:
Mailing address:
  • Phone: 337-546-5740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10615
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: