Provider Demographics
NPI:1467597823
Name:DAVIS, CRYSTAL DAWN (BS)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:DAWN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 S ELKHART WAY
Mailing Address - Street 2:APT. 307
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3808
Mailing Address - Country:US
Mailing Address - Phone:303-743-5960
Mailing Address - Fax:
Practice Address - Street 1:4141 E DICKENSON PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6012
Practice Address - Country:US
Practice Address - Phone:303-504-6648
Practice Address - Fax:303-757-8281
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health