MEDICARE: CRYSTAL DONSHELL ETUK

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	104100000X	Social Worker	104783	TX

General Provider Information

NPI Number	:	1356786768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL DONSHELL ETUK

Provider Business Mailing Address
First Line	:	4107 TRES SABORES LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-0046
Country	:	US
Telephone Number	:	832-353-7695
Fax Number	:

Provider Business Practice Location Address
First Line	:	5598 NORTH FWY STE A-1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77076-4702
Country	:	US
Telephone Number	:	832-353-7695
Fax Number	:

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

Provider Enumeration Date	:	04/30/2013
Last Update Date	:	12/11/2023

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Directions to “ CRYSTAL DONSHELL ETUK ” Practice Location

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