Healthcare Provider Details

I. General information

NPI: 1689039018
Provider Name (Legal Business Name): KRYSTAL RICHARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4635 SOUTHWEST FWY STE 635
HOUSTON TX
77027-7112
US

IV. Provider business mailing address

42 JANA DR
MONROE LA
71203-2778
US

V. Phone/Fax

Practice location:
  • Phone: 713-850-0049
  • Fax: 713-627-7302
Mailing address:
  • Phone: 318-547-4208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11495
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: