1609173103 NPI number — CRYSTAL LEE KUYANA SPECHT LMHC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609173103 NPI number — CRYSTAL LEE KUYANA SPECHT LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPECHT
Provider First Name:
CRYSTAL
Provider Middle Name:
LEE KUYANA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACKSON
Provider Other First Name:
CRYSTAL
Provider Other Middle Name:
LEE KUYANA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609173103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15106 S GRANITE LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHENEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99004-9668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-720-9417
Provider Business Mailing Address Fax Number:
509-467-0344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 N HOWARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-467-7913
Provider Business Practice Location Address Fax Number:
509-467-0344
Provider Enumeration Date:
02/17/2011

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: 101YM0800X , with the licence number:  LH60200915 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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