Provider Demographics
NPI:1689290140
Name:MOLINA, CRYSTAL (MFT, APCC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4795
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90231-4795
Mailing Address - Country:US
Mailing Address - Phone:657-549-2702
Mailing Address - Fax:
Practice Address - Street 1:16940 HIGHWAY 14 STE F
Practice Address - Street 2:
Practice Address - City:MOJAVE
Practice Address - State:CA
Practice Address - Zip Code:93501-1238
Practice Address - Country:US
Practice Address - Phone:661-824-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140516106H00000X
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist