Provider Demographics
NPI:1639442031
Name:VILLANUEVA, CRYSTAL R (LMFT #135253)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:R
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:LMFT #135253
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 BALTRA WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-7424
Mailing Address - Country:US
Mailing Address - Phone:661-381-6679
Mailing Address - Fax:661-868-6133
Practice Address - Street 1:11211 BALTRA WAY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-7424
Practice Address - Country:US
Practice Address - Phone:661-381-6679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF96781106H00000X
390200000X
CA135253106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program