Healthcare Provider Details

I. General information

NPI: 1225315104
Provider Name (Legal Business Name): CRYSTAL ERLENE JONES MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL ERLENE RANDOLPH MHC

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 GLENWOOD BLVD
SCHENECTADY NY
12308-2910
US

IV. Provider business mailing address

1094 GLENWOOD BLVD
SCHENECTADY NY
12308-2910
US

V. Phone/Fax

Practice location:
  • Phone: 518-557-9651
  • Fax:
Mailing address:
  • Phone: 518-275-8009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number011122-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: