Provider Demographics
NPI:1578860987
Name:JAMES, KRYSTAL JANELLE
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:JANELLE
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:JANELLE
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5450 BRUCE B DOWNS BLVD STE 372
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-8616
Mailing Address - Country:US
Mailing Address - Phone:951-750-3746
Mailing Address - Fax:
Practice Address - Street 1:27027 HOLLYBROOK TRL
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7435
Practice Address - Country:US
Practice Address - Phone:951-750-3746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12894552-3902106H00000X
GAMFT001949106H00000X
CA97088106H00000X
FL3685106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist