Healthcare Provider Details

I. General information

NPI: 1417482860
Provider Name (Legal Business Name): CRYSTAL FORBES LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL CAMERON LMHC

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 PARADISE LN
LAS CRUCES NM
88007-5652
US

IV. Provider business mailing address

2521 N MAIN ST STE 1
LAS CRUCES NM
88001-1171
US

V. Phone/Fax

Practice location:
  • Phone: 575-339-5534
  • Fax:
Mailing address:
  • Phone: 575-339-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0201851
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0184801
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: