Individual
MRS. CRYSTAL MARIE WITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7435 E MAIN ST, MESA, AZ 85207-8337
(480) 590-5293
(480) 564-1060
Mailing address
1177 S SILVERADO ST, GILBERT, AZ 85296-0924
(602) 492-2125
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LISAC-15094
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LISAC-15094
LISAC
AZ
Enumeration date
06/07/2019
Last updated
12/07/2022
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