MEDICARE: MRS. CRYSTAL ALEXIA JEFFREY LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	13042	TX
2	101Y00000X	Counselor	13042	TX
3	171M00000X	Case Manager/Care Coordinator
4	261QM0850X	Adult Mental Health Clinic/Center		TX
5	251B00000X	Case Management Agency		TX

General Provider Information

NPI Number	:	1548724404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRYSTAL ALEXIA JEFFREY LCDC

Provider Business Mailing Address
First Line	:	16714 SIDONIE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-2562
Country	:	US
Telephone Number	:	832-721-3005
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 BONHOMME RD STE 174N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-4367
Country	:	US
Telephone Number	:	832-864-3347
Fax Number	:	833-241-7558

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

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	10/31/2025

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