Healthcare Provider Details

I. General information

NPI: 1346919776
Provider Name (Legal Business Name): CRYSTAL M GUYSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3936 E. FRONTAGE RD HWY 52. N.
ROCHESTER MN
55960
US

IV. Provider business mailing address

781 RIVER PARK LN SE
ORONOCO MN
55960-2088
US

V. Phone/Fax

Practice location:
  • Phone: 507-358-6663
  • Fax:
Mailing address:
  • Phone: 507-358-6663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. CRYSTAL MARIE GUYSE
Title or Position: PSYCHOLOGIST
Credential: MA, LP, LICSW
Phone: 507-358-6663