Provider Demographics
NPI:1417317629
Name:WILLSON, CRYSTAL (LMHC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:WILLSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:MARIE
Other - Last Name:CRENSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18786 HAMPSTEAD HEATH CT
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-0025
Mailing Address - Country:US
Mailing Address - Phone:352-650-1274
Mailing Address - Fax:
Practice Address - Street 1:18786 HAMPSTEAD HEATH CT
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-0025
Practice Address - Country:US
Practice Address - Phone:352-650-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13762101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health