Individual
CRYSTAL ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
218 BROADWAY BLVD SE, ALBUQUERQUE, NM 87102-3425
(505) 242-6988
(505) 242-6972
Mailing address
218 BROADWAY BLVD SE, ALBUQUERQUE, NM 87102-3425
(505) 242-6988
(505) 242-6972
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-10657
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58373381
—
NM
Enumeration date
07/13/2015
Last updated
07/21/2022
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