Provider Demographics
NPI:1336304278
Name:EDWARDS, CRYSTAL HAYSE (NHC, LMT, NTS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:HAYSE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:NHC, LMT, NTS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 ESSEX DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4719
Mailing Address - Country:US
Mailing Address - Phone:505-896-0539
Mailing Address - Fax:
Practice Address - Street 1:5603 ESSEX DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4719
Practice Address - Country:US
Practice Address - Phone:505-896-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5546225700000X
NMCTB-2023-0078101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist