Provider Demographics
NPI:1619246774
Name:NIEHAUS, CRYSTAL LYNN (MHP)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LYNN
Last Name:NIEHAUS
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:MRS
Other - First Name:CRYSTAL
Other - Middle Name:LYNN
Other - Last Name:SCHARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHP
Mailing Address - Street 1:5588 N PALM AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1913
Mailing Address - Country:US
Mailing Address - Phone:559-341-7120
Mailing Address - Fax:
Practice Address - Street 1:5588 N PALM AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1913
Practice Address - Country:US
Practice Address - Phone:559-341-7120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT83621106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist