Provider Demographics
NPI:1225725047
Name:STEPHEN, KRYSTAL (PHD)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:STEPHEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 WALLOWA DR LOT 248
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-7919
Mailing Address - Country:US
Mailing Address - Phone:832-228-8009
Mailing Address - Fax:
Practice Address - Street 1:725 WALLOWA DR LOT 248
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-7919
Practice Address - Country:US
Practice Address - Phone:832-228-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling