1023779352 NPI number — MS. CRYSTAL D. NELSON PHD, NCC, LPC CCTP-I

Table of content: MS. CRYSTAL D. NELSON PHD, NCC, LPC CCTP-I (NPI 1023779352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023779352 NPI number — MS. CRYSTAL D. NELSON PHD, NCC, LPC CCTP-I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
CRYSTAL
Provider Middle Name:
D.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHD, NCC, LPC CCTP-I
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NELSON
Provider Other First Name:
CRYSY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, NCC, LPC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023779352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2341 FARNUM ST UNIT D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82609-4120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-578-1097
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 S CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601-2826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-251-1852
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC-1994 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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