Provider Demographics
NPI:1417261694
Name:MIYAKE, CRISSY TAMIKO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CRISSY
Middle Name:TAMIKO
Last Name:MIYAKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CRISSY
Other - Middle Name:TAMIKO
Other - Last Name:MCNEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:5351C JAYCEE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2997
Mailing Address - Country:US
Mailing Address - Phone:717-657-2080
Mailing Address - Fax:
Practice Address - Street 1:5351C JAYCEE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2997
Practice Address - Country:US
Practice Address - Phone:717-657-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016761103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical