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General NPI Number Information
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NPI Number | 1669846234
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Entity Type | Individual
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Provider Name | CRYSTAL MICHELLE SHIMIZU M.A., BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 1201 PEACHTREE ST NE STE AND300
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City | ATLANTA
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State | GA
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Zip | 30361-3503
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Country | US
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Telephone | 678-400-5040
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Fax |
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Provider Business Mailing Address
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Address Line | 19517 138TH AVE SE
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City | RENTON
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State | WA
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Zip | 98058-7742
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Country | US
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Telephone | 818-304-1313
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-15-18868
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License Number State | CA
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