Provider Demographics
NPI:1225409733
Name:BINGHAM, CRYSTAL (MS)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N BEECH ST
Mailing Address - Street 2:PREVENTIVE MEASURES PROGRAMS
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-3809
Mailing Address - Country:US
Mailing Address - Phone:318-574-0098
Mailing Address - Fax:318-574-0066
Practice Address - Street 1:805 N BEECH ST
Practice Address - Street 2:PREVENTIVE MEASURES PROGRAMS
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-3809
Practice Address - Country:US
Practice Address - Phone:318-574-0098
Practice Address - Fax:318-574-0066
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor