Healthcare Provider Details

I. General information

NPI: 1679939367
Provider Name (Legal Business Name): CRISSY WEBSTER M.A., LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 WALL ST STE 12
SPRINGFIELD VT
05156-3528
US

IV. Provider business mailing address

156 WALL ST STE 12
SPRINGFIELD VT
05156-3528
US

V. Phone/Fax

Practice location:
  • Phone: 802-952-8671
  • Fax:
Mailing address:
  • Phone: 802-952-8671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1097
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0102416
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: