A CRYSTAL MIND

Provider Demographics

• NPI: 1467068262
• Name: A CRYSTAL MIND
• Entity Type: Organization
• Organization Name: A CRYSTAL MIND
• Authorized Official - Title/Position: OWNER
• Authorized Official - First Name: CRYSTAL
• Authorized Official - Last Name: FARRELL
• Authorized Official - Credentials: MSN, CNP
• Authorized Official - Phone: 513-923-6336
• Mailing Address - Street 1: PO BOX 1441
• Mailing Address - City: WEST CHESTER
• Mailing Address - State: OH
• Mailing Address - Zip Code: 45071-1441
• Mailing Address - Country: US
• Mailing Address - Phone: 513-923-6336
• Mailing Address - Fax: 562-261-1296
• Practice Address - Street 1: 4015 EXECUTIVE PARK DR STE 310
• Practice Address - City: CINCINNATI
• Practice Address - State: OH
• Practice Address - Zip Code: 45241-4015
• Practice Address - Country: US
• Practice Address - Phone: 513-923-6336
• Practice Address - Fax: 562-261-1296
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2020-09-17
• Last Update Date: 2021-01-16

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	363LP0808X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Psychiatric/Mental Health	Group - Multi-Specialty
No	251S00000X	Agencies	Community/Behavioral Health
No	261QM0801X	Ambulatory Health Care Facilities	Clinic/Center	Mental Health (Including Community Mental Health Center)
No	261QM0850X	Ambulatory Health Care Facilities	Clinic/Center	Adult Mental Health
No	261QM0855X	Ambulatory Health Care Facilities	Clinic/Center	Adolescent and Children Mental Health
No	3104A0625X	Nursing & Custodial Care Facilities	Assisted Living Facility	Assisted Living, Mental Illness
No	310500000X	Nursing & Custodial Care Facilities	Intermediate Care Facility, Mental Illness
No	311500000X	Nursing & Custodial Care Facilities	Alzheimer Center (Dementia Center)
No	320800000X	Residential Treatment Facilities	Community Based Residential Treatment Facility, Mental Illness		Group - Multi-Specialty