=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972111714
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRYSTOL ALPERT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2020
-----------------------------------------------------
Last Update Date | 01/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 635 S MAPLE RD STE 2
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48103-3838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-645-8944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1035 SAN PABLO AVE STE 9-3
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94706-2275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 18032
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------