Provider Demographics
NPI:1417482860
Name:FORBES, CRYSTAL (LPCC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:FORBES
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:CAMERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 1050
Mailing Address - Street 2:
Mailing Address - City:FAIRACRES
Mailing Address - State:NM
Mailing Address - Zip Code:88033-1050
Mailing Address - Country:US
Mailing Address - Phone:575-339-5534
Mailing Address - Fax:
Practice Address - Street 1:2881 SAN LORENZO CT
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-1969
Practice Address - Country:US
Practice Address - Phone:575-520-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0184801101YM0800X
NMCCMH0201851101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM24152226Medicaid