Provider Demographics
NPI:1558782235
Name:JAMES, CRYSTAL (MS)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7451 W GLENBROOK RD APT 212
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1125
Mailing Address - Country:US
Mailing Address - Phone:414-573-2579
Mailing Address - Fax:414-466-3206
Practice Address - Street 1:7451 W GLENBROOK RD APT 212
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-1125
Practice Address - Country:US
Practice Address - Phone:414-573-2579
Practice Address - Fax:414-466-3206
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health