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General NPI Number Information
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NPI Number | 1962383794
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Entity Type | Organization
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Legal Business Name | CRYSTAL MANJARREZ PLLC
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 2504 LOMBARD AVE
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City | BERWYN
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State | IL
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Zip | 60402-2615
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Country | US
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Telephone | 708-232-6076
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Fax |
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Provider Business Mailing Address
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Address Line | 680 N LAKE SHORE DR STE 110-2163
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRYSTAL MANJARREZ
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Credential |
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Telephone | 708-717-4206
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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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