Provider Demographics
NPI:1346919776
Name:CRYSTAL M GUYSE, LLC
Entity Type:Organization
Organization Name:CRYSTAL M GUYSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUYSE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LP, LICSW
Authorized Official - Phone:507-358-6663
Mailing Address - Street 1:781 RIVER PARK LN SE
Mailing Address - Street 2:
Mailing Address - City:ORONOCO
Mailing Address - State:MN
Mailing Address - Zip Code:55960-2088
Mailing Address - Country:US
Mailing Address - Phone:507-358-6663
Mailing Address - Fax:
Practice Address - Street 1:3936 E. FRONTAGE RD HWY 52. N.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55960
Practice Address - Country:US
Practice Address - Phone:507-358-6663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty