Provider Demographics
NPI:1538657473
Name:FLINT, CRYSTAL MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARIE
Last Name:FLINT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8202 NE STATE HIGHWAY 104 STE 102-159
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-9454
Mailing Address - Country:US
Mailing Address - Phone:360-540-3282
Mailing Address - Fax:
Practice Address - Street 1:26220 DUNGENESS AVE NE # C129
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-4518
Practice Address - Country:US
Practice Address - Phone:360-860-7529
Practice Address - Fax:360-972-7460
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-28525103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst