Provider Demographics
NPI:1033415062
Name:MOSBY, CRYSTAL JOANN (LLPC)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:JOANN
Last Name:MOSBY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27601 MORNINGSIDE PLZ
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3266
Mailing Address - Country:US
Mailing Address - Phone:313-706-6306
Mailing Address - Fax:
Practice Address - Street 1:27601 MORNINGSIDE PLZ
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-3266
Practice Address - Country:US
Practice Address - Phone:313-706-6306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006613101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional