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General NPI Number Information
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NPI Number | 1770722886
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Entity Type | Individual
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Provider Name | CRYSTAL LEAH CLUNE LMFT 139013
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Gender | Female
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 412 E MAIN ST STE J
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City | GRASS VALLEY
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State | CA
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Zip | 95945-6533
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Country | US
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Telephone | 530-575-6120
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Fax | 530-575-6120
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Provider Business Mailing Address
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Address Line | 13010 DAISY BLUE MINE RD
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City | NEVADA CITY
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State | CA
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Zip | 95959-9708
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Country | US
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Telephone | 530-575-6120
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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 |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF62333
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 139013
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License Number State | CA
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