Organization
C CRYSTAL PSYCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHANA D CRYSTAL PSYD, EDS (OWNER)
(314) 308-7772
Entity
Organization
Contact information
Practice address
2810 MACK RD, FAIRFIELD, OH 45014-5130
(314) 308-7772
(314) 308-7772
Mailing address
2810 MACK RD, FAIRFIELD, OH 45014-5130
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TS0200X
School Psychologist
—
—
Other
Enumeration date
05/16/2017
Last updated
05/16/2017
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