MEDICARE: KRYSTAL SEALE

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	106H00000X	Marriage & Family Therapist	304576	KY

General Provider Information

NPI Number	:	1629935549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL SEALE

Provider Business Mailing Address
First Line	:	3136 HIGH RIDGE DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4052
Country	:	US
Telephone Number	:	859-771-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 CUSTER DR STE 202
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4010
Country	:	US
Telephone Number	:	502-219-3488
Fax Number	:

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

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “ KRYSTAL SEALE ” Practice Location

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