Provider Demographics
NPI:1093257644
Name:CRISTAL VILLALOBOS
Entity Type:Organization
Organization Name:CRISTAL VILLALOBOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CRISTAL
Authorized Official - Middle Name:MARIBEL
Authorized Official - Last Name:VILLALOBOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:559-790-3251
Mailing Address - Street 1:758 N PALM ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:93286-1023
Mailing Address - Country:US
Mailing Address - Phone:559-790-3251
Mailing Address - Fax:
Practice Address - Street 1:216 E PINE ST
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1750
Practice Address - Country:US
Practice Address - Phone:559-376-0763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS29336251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health