Provider Demographics
NPI:1639563984
Name:OLMSTEAD, CRYSTAL LOUISE (PCC#3819ANDLSW#21302)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:LOUISE
Last Name:OLMSTEAD
Suffix:
Gender:F
Credentials:PCC#3819ANDLSW#21302
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 ARBOR BLVD.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1521
Mailing Address - Country:US
Mailing Address - Phone:937-222-9481
Mailing Address - Fax:937-222-3710
Practice Address - Street 1:2211 ARBOR BLVD.
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45439-1521
Practice Address - Country:US
Practice Address - Phone:937-222-9481
Practice Address - Fax:937-222-3710
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPCC#E318101Y00000X
OHLSW#521302104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor