MEDICARE: CRYSTAL LYNN ARAGON M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1144549247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL LYNN ARAGON M.A.

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 MARQUETTE AVE NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-5340
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2010
Last Update Date	:	10/02/2020

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