Provider Demographics
NPI:1467018242
Name:REDDING, CRYSTAL MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:MARIE
Last Name:REDDING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GRAND VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-4798
Mailing Address - Country:US
Mailing Address - Phone:910-922-3242
Mailing Address - Fax:
Practice Address - Street 1:110 GRAND VIEW CIR
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-4798
Practice Address - Country:US
Practice Address - Phone:910-922-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY690103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic