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General NPI Number Information
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NPI Number | 1598397697
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Entity Type | Organization
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Legal Business Name | CRYSTAL EATON LCMHC LLC
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Dates
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Enumeration Date | 02/06/2020
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 76 NORTHEASTERN BLVD STE 32B
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City | NASHUA
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State | NH
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Zip | 03062-3196
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Country | US
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Telephone | 978-419-1781
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Fax |
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Provider Business Mailing Address
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Address Line | 76 NORTHEASTERN BLVD STE 32B
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City | NASHUA
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State | NH
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Zip | 03062-3196
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Country | US
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Telephone | 978-419-1781
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | CRYSTAL EATON
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Credential | LCMHC
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Telephone | 978-419-1781
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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 |
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License Number State |
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