Healthcare Provider Details

I. General information

NPI: 1295668010
Provider Name (Legal Business Name): CRYSTAL M DELOACH PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W GALER ST
SEATTLE WA
98119-3332
US

IV. Provider business mailing address

210 W GALER ST
SEATTLE WA
98119-3332
US

V. Phone/Fax

Practice location:
  • Phone: 206-448-6944
  • Fax:
Mailing address:
  • Phone: 206-448-6944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CRYSTAL DELOACH
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 206-448-6944