MEDICARE: CRYSTAL WINFORD

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	1602544066	NV
2	103K00000X	Behavior Analyst		NV

General Provider Information

NPI Number	:	1265941504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL WINFORD

Provider Business Mailing Address
First Line	:	3858 FALCON SPRINGS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-4277
Country	:	US
Telephone Number	:	702-488-3167
Fax Number	:

Provider Business Practice Location Address
First Line	:	3858 FALCON SPRINGS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-4277
Country	:	US
Telephone Number	:	702-488-3167
Fax Number	:

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

Provider Enumeration Date	:	09/28/2017
Last Update Date	:	07/21/2022

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Directions to “ CRYSTAL WINFORD ” Practice Location

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