Individual
CRYSTAL LEAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
3504 INDUSTRIAL AVE STE 214, FAIRBANKS, AK 99701-7390
(907) 452-4673
(907) 452-1430
Mailing address
3504 INDUSTRIAL AVE STE 214, FAIRBANKS, AK 99701-7390
(907) 452-4673
(907) 452-1430
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
806
AK
Other
Enumeration date
09/29/2014
Last updated
09/29/2014
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