Healthcare Provider Details

I. General information

NPI: 1770992968
Provider Name (Legal Business Name): CRYSTAL WILLIAMS M.A, NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 NELDA CIR
STONEWALL LA
71078-5412
US

IV. Provider business mailing address

189 NELDA CIR
STONEWALL LA
71078-5412
US

V. Phone/Fax

Practice location:
  • Phone: 318-245-3906
  • Fax:
Mailing address:
  • Phone: 318-245-3906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4367
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: