Provider Demographics
NPI:1477095651
Name:KEHL, CRYSTAL (LPC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:KEHL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 GAINSVILLE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1050
Mailing Address - Country:US
Mailing Address - Phone:813-785-0137
Mailing Address - Fax:
Practice Address - Street 1:5114 GAINSVILLE DR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1050
Practice Address - Country:US
Practice Address - Phone:813-785-0137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-05
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health