Provider Demographics
NPI:1457500944
Name:WARD, CRYSTAL KAY (MFTI)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:KAY
Last Name:WARD
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:KAY
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9343 TECH CENTER DR
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2563
Mailing Address - Country:US
Mailing Address - Phone:916-764-5310
Mailing Address - Fax:
Practice Address - Street 1:9343 TECH CENTER DR
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2563
Practice Address - Country:US
Practice Address - Phone:916-388-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA62957106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor