Provider Demographics
NPI:1538520036
Name:VENEGAS, CRYSTAL (LMFT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:VENEGAS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 BASE LINE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5827
Mailing Address - Country:US
Mailing Address - Phone:626-696-8665
Mailing Address - Fax:
Practice Address - Street 1:9330 BASE LINE RD STE 102
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-5827
Practice Address - Country:US
Practice Address - Phone:626-696-8665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107055106H00000X
CA125525106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist