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General NPI Number Information
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NPI Number | 1356786768
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Entity Type | Individual
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Provider Name | CRYSTAL DONSHELL ETUK
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Gender | Female
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 5598 NORTH FWY STE A-1
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City | HOUSTON
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State | TX
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Zip | 77076-4702
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Country | US
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Telephone | 832-353-7695
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Fax |
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Provider Business Mailing Address
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Address Line | 4107 TRES SABORES LN
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City | KATY
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State | TX
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Zip | 77449-0046
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Country | US
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Telephone | 832-353-7695
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 104783
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License Number State | TX
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