Provider Demographics
NPI:1497351332
Name:CRISWELL, DAVID DEAN (MA, LPC, ACAS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DEAN
Last Name:CRISWELL
Suffix:
Gender:M
Credentials:MA, LPC, ACAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E MOSLEY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-7251
Mailing Address - Country:US
Mailing Address - Phone:936-668-5963
Mailing Address - Fax:
Practice Address - Street 1:116 E MOSLEY LN
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-7251
Practice Address - Country:US
Practice Address - Phone:936-668-5963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional