Individual
DR. CHANA CRYSTAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2812 MACK RD, FAIRFIELD, OH 45014-5130
(513) 666-0816
Mailing address
2812 MACK RD, FAIRFIELD, OH 45014-5130
(513) 666-0816
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
7554
OH
103TS0200X
School Psychologist
7554
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CS180030014
CARESOURCE
OH
Enumeration date
02/07/2018
Last updated
03/15/2019
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