MEDICARE: CRYSTAL WINN LPC

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	101YP2500X	Professional Counselor	80720	TX

General Provider Information

NPI Number	:	1497159719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL WINN LPC

Provider Business Mailing Address
First Line	:	1300 DACY LN STE 120
Second Line	:
City	:	KYLE
State	:	TX
Zip	:	78640-4194
Country	:	US
Telephone Number	:	512-392-8953
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 DACY LN STE 120
Second Line	:
City	:	KYLE
State	:	TX
Zip	:	78640-4194
Country	:	US
Telephone Number	:	512-392-8953
Fax Number	:

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

Provider Enumeration Date	:	10/15/2014
Last Update Date	:	06/21/2019

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Directions to “ CRYSTAL WINN LPC” Practice Location

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