Provider Demographics
NPI:1477225969
Name:ANDERSON, KRYSTAL JOHANNA (LSC)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:JOHANNA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E CROSSROADS BLVD # 619
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-2966
Mailing Address - Country:US
Mailing Address - Phone:801-829-1034
Mailing Address - Fax:
Practice Address - Street 1:3871 W 1700 N
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4183
Practice Address - Country:US
Practice Address - Phone:801-829-1034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT682813101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool