Individual
CRYSTAL ANN NYSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
2335 MAIN ST, LEWISTON, ID 83501-3242
(208) 791-0129
(208) 743-1170
Mailing address
2901 MEADOWLARK DR, LEWISTON, ID 83501-9668
(208) 791-0129
(208) 743-1170
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
60098856
WA
101YP2500X
Professional Counselor
Primary
5700
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0675366780
HPSO LIABILITY INSURANCE
—
Enumeration date
01/21/2019
Last updated
01/21/2019
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