Provider Demographics
NPI:1326678509
Name:CARTER, CRYSTAL (PLPC, NCC, BC-TMH)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:PLPC, NCC, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE
Mailing Address - State:MS
Mailing Address - Zip Code:38650-9616
Mailing Address - Country:US
Mailing Address - Phone:662-507-9906
Mailing Address - Fax:
Practice Address - Street 1:2180 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4205
Practice Address - Country:US
Practice Address - Phone:901-276-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN5069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional