Provider Demographics
NPI:1043766470
Name:MCKENNA, CRYSTAL (MS, LMHC, NCC, CCMHC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MS, LMHC, NCC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SPAULDING RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03044-3252
Mailing Address - Country:US
Mailing Address - Phone:207-482-0640
Mailing Address - Fax:
Practice Address - Street 1:4C FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2819
Practice Address - Country:US
Practice Address - Phone:207-482-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHMH2012101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)