Provider Demographics
NPI:1710099031
Name:CHANG, CRYSTAL LENA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LENA
Last Name:CHANG
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MISS
Other - First Name:CRYSTAL
Other - Middle Name:LENA
Other - Last Name:CHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:4159 CANDLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4451
Mailing Address - Country:US
Mailing Address - Phone:940-636-4773
Mailing Address - Fax:
Practice Address - Street 1:4159 CANDLEWOOD CIR
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4451
Practice Address - Country:US
Practice Address - Phone:940-636-4773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31345104100000X
TX62963101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T22YOtherBCBS #
TX111408401Medicaid
TX111408402Medicaid
TX111408401Medicaid