MEDICARE: CRYSTAL FORBES LPCC

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	101YM0800X	Mental Health Counselor	0184801	NM
2	101YP2500X	Professional Counselor	CCMH0201851	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417482860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL FORBES LPCC

Provider Business Mailing Address
First Line	:	PO BOX 1050
Second Line	:
City	:	FAIRACRES
State	:	NM
Zip	:	88033-1050
Country	:	US
Telephone Number	:	575-339-5534
Fax Number	:

Provider Business Practice Location Address
First Line	:	2881 SAN LORENZO CT
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-1969
Country	:	US
Telephone Number	:	575-520-5205
Fax Number	:

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

Provider Enumeration Date	:	04/24/2017
Last Update Date	:	03/22/2023

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Directions to “ CRYSTAL FORBES LPCC” Practice Location

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