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General NPI Number Information
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NPI Number | 1154055747
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Entity Type | Individual
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Provider Name | CRYSTAL LOUISE PERDUE LPC
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Gender | Female
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 1317 MANDARIN ISLE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33315-1648
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Country | US
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Telephone | 913-432-7722
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 25331
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City | MIAMI
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State | FL
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Zip | 33102-5331
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Country | US
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Telephone | 913-432-7722
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2019006727
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH20972
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License Number State | FL
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