Healthcare Provider Details

I. General information

NPI: 1326709759
Provider Name (Legal Business Name): CRYSTAL DAO MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 LEGACY DR STE 270
PLANO TX
75024-3363
US

IV. Provider business mailing address

2827 GILLESPIE LN
GRAND PRAIRIE TX
75052-0729
US

V. Phone/Fax

Practice location:
  • Phone: 972-865-8782
  • Fax: 972-499-6935
Mailing address:
  • Phone: 682-558-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number84037
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: