Provider Demographics
NPI:1255000519
Name:GALLEGOS, CRYSTAL EVE (LMFT, PPSC, CWA)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:EVE
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:LMFT, PPSC, CWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4256 AVENIDA SIMI
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-1605
Mailing Address - Country:US
Mailing Address - Phone:661-378-8118
Mailing Address - Fax:
Practice Address - Street 1:4256 AVENIDA SIMI
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-1605
Practice Address - Country:US
Practice Address - Phone:661-378-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53956106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist