Provider Demographics
NPI:1417308834
Name:TORRES, CRYSTAL CUELLAR
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:CUELLAR
Last Name:TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 764
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93011
Mailing Address - Country:US
Mailing Address - Phone:805-754-7080
Mailing Address - Fax:
Practice Address - Street 1:2500 S C STREET SUITE C
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033
Practice Address - Country:US
Practice Address - Phone:805-385-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist