Individual
MRS. CRYSTAL LOUISE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
307 W COTA ST, SHELTON, WA 98584-2265
(360) 839-2822
(360) 839-2822
Mailing address
19206 21ST ST SW, LAKEBAY, WA 98349-9280
(125) 329-2888
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000034753
—
WA
Enumeration date
07/15/2020
Last updated
07/15/2020
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