Provider Demographics
NPI:1225392038
Name:WILLIAMS, KRYSTALYNN LOIS
Entity Type:Individual
Prefix:
First Name:KRYSTALYNN
Middle Name:LOIS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11195 DAYLILLY ST
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-6827
Mailing Address - Country:US
Mailing Address - Phone:951-609-5099
Mailing Address - Fax:
Practice Address - Street 1:11195 DAYLILLY ST
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-6827
Practice Address - Country:US
Practice Address - Phone:951-609-5099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist