Provider Demographics
NPI:1497159719
Name:WINN, CRYSTAL (LPC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:WINN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:WINN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1300 DACY LN STE 120
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-4194
Mailing Address - Country:US
Mailing Address - Phone:512-392-8953
Mailing Address - Fax:
Practice Address - Street 1:1300 DACY LN STE 120
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-4194
Practice Address - Country:US
Practice Address - Phone:512-392-8953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80720101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional