Provider Demographics
NPI:1427367044
Name:ABRAHAM, KRYSTAL NADINE
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:NADINE
Last Name:ABRAHAM
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 1:655 E 1300 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341
Mailing Address - Country:US
Mailing Address - Phone:435-792-6491
Mailing Address - Fax:435-792-6608
Practice Address - Street 1:655 E 1300 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341
Practice Address - Country:US
Practice Address - Phone:435-792-6491
Practice Address - Fax:435-792-6608
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor