Healthcare Provider Details

I. General information

NPI: 1831741818
Provider Name (Legal Business Name): CRYSTAL SCHACKAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9480 THREE RIVERS RD
GULFPORT MS
39503-4248
US

IV. Provider business mailing address

102 KELLEY CV
PASS CHRISTIAN MS
39571-2226
US

V. Phone/Fax

Practice location:
  • Phone: 228-313-3106
  • Fax:
Mailing address:
  • Phone: 504-756-9044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: