MEDICARE: CRYSTAL LANTRIP PH.D.

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	103G00000X	Clinical Neuropsychologist	36801	TX

General Provider Information

NPI Number	:	1912384975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL LANTRIP PH.D.

Provider Business Mailing Address
First Line	:	8009 CHERVIL DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8917
Country	:	US
Telephone Number	:	512-270-0511
Fax Number	:	512-655-9597

Provider Business Practice Location Address
First Line	:	7000 N MOPAC EXPY STE 2127
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-2689
Country	:	US
Telephone Number	:	512-270-0511
Fax Number	:	512-655-9597

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

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	03/29/2022

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