Provider Demographics
NPI:1679932016
Name:PASSMORE, CRYSTAL GAYLE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:GAYLE
Last Name:PASSMORE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 12TH ST STE 334
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2462
Mailing Address - Country:US
Mailing Address - Phone:706-225-0322
Mailing Address - Fax:706-225-0321
Practice Address - Street 1:233 12TH ST STE 334
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901
Practice Address - Country:US
Practice Address - Phone:706-225-0322
Practice Address - Fax:706-225-0321
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-13
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional