# A CRYSTAL MIND

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467068262
- **Authorized official:** CRYSTAL FARRELL MSN, CNP (OWNER)
- **Authorized official phone:** (513) 923-6336

## Contact information

- **Practice address:** 4015 EXECUTIVE PARK DR STE 310, CINCINNATI, OH 45241-4015
- **Practice address phone:** (513) 923-6336
- **Practice address fax:** (562) 261-1296
- **Mailing address:** PO BOX 1441, WEST CHESTER, OH 45071-1441
- **Mailing address phone:** (513) 923-6336
- **Mailing address fax:** (562) 261-1296

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 3104A0625X | Assisted Living Facility (Mental Illness) | — | NULL | — |
| 310500000X | Mental Illness Intermediate Care Facility | — | NULL | — |
| 311500000X | Alzheimer Center (Dementia Center) | — | NULL | — |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/17/2020
- **Last updated:** 01/16/2021