Provider Demographics
NPI:1558035477
Name:PATTERSON, CRYSTAL
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PAPPAS BLVD
Mailing Address - Street 2:NULL
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341
Mailing Address - Country:US
Mailing Address - Phone:832-444-6030
Mailing Address - Fax:
Practice Address - Street 1:136 W 21ST AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-2721
Practice Address - Country:US
Practice Address - Phone:307-532-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty