Provider Demographics
NPI:1316377658
Name:BURTS, CRYSTAL (LCSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:BURTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:DEANNA
Other - Last Name:GAVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:WEIRSDALE
Mailing Address - State:FL
Mailing Address - Zip Code:32195-0204
Mailing Address - Country:US
Mailing Address - Phone:904-400-1634
Mailing Address - Fax:
Practice Address - Street 1:921 N DAVIS ST
Practice Address - Street 2:BUILDING B SUITE 350
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6804
Practice Address - Country:US
Practice Address - Phone:904-337-1247
Practice Address - Fax:904-798-4763
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-23
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW147351041C0700X
FLISW65581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty