Individual
MRS. CRYSTAL ANN BOSTOW LIDDYCOAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LAC, LPC
Contact information
Practice address
726 13TH AVE E, WEST FARGO, ND 58078-3304
(971) 500-2661
Mailing address
2910 38TH AVE S, FARGO, ND 58104-7061
(530) 799-0499
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1596
ND
101YM0800X
Mental Health Counselor
Primary
621-12-15-08
ND
101YM0800X
Mental Health Counselor
CP6207-R
NV
Other
Enumeration date
03/04/2009
Last updated
01/13/2026
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