Provider Demographics
NPI:1710339346
Name:PRICE, CRYSTAL (CADC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2632
Mailing Address - Country:US
Mailing Address - Phone:712-263-5065
Mailing Address - Fax:712-263-6366
Practice Address - Street 1:1233 BROADWAY
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2632
Practice Address - Country:US
Practice Address - Phone:712-263-5065
Practice Address - Fax:712-263-6366
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16085101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)