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General NPI Number Information
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NPI Number | 1386351153
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Entity Type | Individual
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Provider Name | CRYSTA DILLASHAW LMSW
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Gender | Female
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Dates
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Enumeration Date | 11/01/2022
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 6021 FAIRMONT PKWY STE 200
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City | PASADENA
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State | TX
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Zip | 77505-4511
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Country | US
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Telephone | 281-769-2238
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Fax |
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Provider Business Mailing Address
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Address Line | 2888 ROCKY CREEK LN
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City | DICKINSON
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State | TX
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Zip | 77539-4052
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Country | US
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Telephone | 713-851-4320
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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 | 109020
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License Number State | TX
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