Healthcare Provider Details

I. General information

NPI: 1568147734
Provider Name (Legal Business Name): CRYSTAL ANN HAYMOND LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL ANN MAYLE LPC

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 GRIFFIN RD
WEST BRANCH MI
48661-9251
US

IV. Provider business mailing address

8435 POTOMAC
CENTER LINE MI
48015-1623
US

V. Phone/Fax

Practice location:
  • Phone: 989-345-5571
  • Fax:
Mailing address:
  • Phone: 248-421-7345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015478
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: