Provider Demographics
NPI:1437829397
Name:GOYDOSCIK-GIBBS, KRYSTAL NICHOLE
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:NICHOLE
Last Name:GOYDOSCIK-GIBBS
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 1:3212 MAIN ST FL 1
Mailing Address - Street 2:
Mailing Address - City:MUNHALL
Mailing Address - State:PA
Mailing Address - Zip Code:15120-3230
Mailing Address - Country:US
Mailing Address - Phone:412-628-9021
Mailing Address - Fax:
Practice Address - Street 1:3212 MAIN ST FL 1
Practice Address - Street 2:
Practice Address - City:MUNHALL
Practice Address - State:PA
Practice Address - Zip Code:15120-3230
Practice Address - Country:US
Practice Address - Phone:412-628-9021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health