MEDICARE: CRYSTAL LYNN ANTOLIN LMFT

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	106H00000X	Marriage & Family Therapist	145035	CA

General Provider Information

NPI Number	:	1306326426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL LYNN ANTOLIN LMFT

Provider Business Mailing Address
First Line	:	10265 ROCKINGHAM DR STE 100-4286
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2523
Country	:	US
Telephone Number	:	916-868-9266
Fax Number	:

Provider Business Practice Location Address
First Line	:	10265 ROCKINGHAM DR STE 100-4286
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2523
Country	:	US
Telephone Number	:	916-868-9266
Fax Number	:

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

Provider Enumeration Date	:	08/17/2018
Last Update Date	:	03/30/2026

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