Provider Demographics
NPI:1578988382
Name:ST JOHN, CRYSTAL ELIZABETH (STUDENT)
Entity Type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:ELIZABETH
Last Name:ST JOHN
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 PALM HILL DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6555
Mailing Address - Country:US
Mailing Address - Phone:760-994-3329
Mailing Address - Fax:
Practice Address - Street 1:32605 TEMECULA PKWY STE 202
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6838
Practice Address - Country:US
Practice Address - Phone:619-383-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist