Individual
MS. CRYSTAL A SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IMFT, LCSW, IBHC
Contact information
Practice address
10448 S PULASKI RD, SUITE 4, OAK LAWN, IL 60453-4895
(312) 834-3697
Mailing address
1342 W TAYLOR ST UNIT 302, CHICAGO, IL 60607-4705
(312) 554-9934
(877) 211-1170
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LPC-125
GU
1041C0700X
Clinical Social Worker
Primary
149014748
IL
1041C0700X
Clinical Social Worker
CW019175
PA
1041C0700X
Clinical Social Worker
LCSW-4503
HI
106H00000X
Marriage & Family Therapist
GU-125
GU
171000000X
Military Health Care Provider
IBHC
GU
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8367001
—
IL
Enumeration date
08/22/2011
Last updated
01/05/2020
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