Individual
CRYSTAL PEOPLES-MIMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
844 ENTRADA, BOSSIER CITY, LA 71111-6274
(318) 572-4532
Mailing address
844 ENTRADA, BOSSIER CITY, LA 71111-6274
(318) 572-4532
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1891130084
LA
Other
Enumeration date
02/04/2017
Last updated
02/04/2017
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