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NPI Code Detail

MEDICARE: CRYSTA DILLASHAW LCSW

MEDICARE:   CRYSTA  DILLASHAW  LCSW
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
11041C0700XClinical Social Worker109020TX

General Provider Information

NPI Number : 1386351153
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTA DILLASHAW LCSW
Provider Business Mailing Address
First Line : 23051 KINGWOOD PLACE DR STE 110
Second Line :
City : KINGWOOD
State : TX
Zip : 77339-3962
Country : US
Telephone Number : 844-824-8775
Fax Number :
Provider Business Practice Location Address
First Line : 23051 KINGWOOD PLACE DR STE 110
Second Line :
City : KINGWOOD
State : TX
Zip : 77339-3962
Country : US
Telephone Number : 844-824-8775
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2022
Last Update Date : 05/26/2026

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Directions to “ CRYSTA DILLASHAW LCSW” Practice Location

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