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General NPI Number Information
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NPI Number | 1326784166
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Entity Type | Individual
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Provider Name | CRYSTAL PAYTON
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Gender | Female
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 107 N HINDE ST
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-1307
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Country | US
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Telephone | 740-620-9293
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Fax |
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Provider Business Mailing Address
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Address Line | 9275 MADISON RD NE
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-8633
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Country | US
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Telephone | 740-505-9408
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 180445
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License Number State | OH
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