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NPI Code Detail

MEDICARE: CRYSTAL GOODS APRN, PMHNP-BC

MEDICARE: CRYSTAL GOODS APRN, PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner209025394IL

General Provider Information

NPI Number : 1730759614
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL GOODS APRN, PMHNP-BC
Provider Business Mailing Address
First Line : 332 S MICHIGAN AVE STE 900
Second Line :
City : CHICAGO
State : IL
Zip : 60604-4393
Country : US
Telephone Number : 773-923-3103
Fax Number : 773-200-3820
Provider Business Practice Location Address
First Line : 213 W INSTITUTE PL STE 500
Second Line :
City : CHICAGO
State : IL
Zip : 60610-8792
Country : US
Telephone Number : 773-923-3103
Fax Number : 773-200-3820
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2021
Last Update Date : 03/14/2026

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