Provider Demographics
NPI:1518119155
Name:CHANEY, CRYSTAL MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARIE
Last Name:CHANEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 ACADEMY RD NE
Mailing Address - Street 2:2724
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7552
Mailing Address - Country:US
Mailing Address - Phone:949-294-8627
Mailing Address - Fax:
Practice Address - Street 1:11600 ACADEMY RD NE
Practice Address - Street 2:2724
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-7552
Practice Address - Country:US
Practice Address - Phone:949-294-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor