Provider Demographics
NPI:1548563836
Name:ANZALONE, CRYSTAL (MS, LMHP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:ANZALONE
Suffix:
Gender:F
Credentials:MS, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11919 GRANT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3475
Mailing Address - Country:US
Mailing Address - Phone:402-598-8511
Mailing Address - Fax:402-504-4584
Practice Address - Street 1:11919 GRANT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3475
Practice Address - Country:US
Practice Address - Phone:402-598-8511
Practice Address - Fax:402-504-4584
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4039101YM0800X
NE1994101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional