Provider Demographics
NPI:1063043743
Name:CHANG-CARTER, CRYSTAL (MS, LCDC,LPC)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:CHANG-CARTER
Suffix:
Gender:F
Credentials:MS, LCDC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 E ROUND GROVE RD APT 2221
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3846
Mailing Address - Country:US
Mailing Address - Phone:469-671-7907
Mailing Address - Fax:
Practice Address - Street 1:405 STATE HIGHWAY 121 BYP STE A250
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4183
Practice Address - Country:US
Practice Address - Phone:469-444-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X
TX81427101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)