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NPI Code Detail

MEDICARE: CRYSTAL HILL

MEDICARE: CRYSTAL HILL
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1500LA
21041C0700XClinical Social Worker11703LA

General Provider Information

NPI Number : 1215300587
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL HILL
Provider Business Mailing Address
First Line : PO BOX 7118
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71306-0118
Country : US
Telephone Number : 318-704-5907
Fax Number :
Provider Business Practice Location Address
First Line : 5411 COLISEUM BLVD
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71303-3729
Country : US
Telephone Number : 318-484-6850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2015
Last Update Date : 04/05/2023

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Directions to “ CRYSTAL HILL ” Practice Location

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