Provider Demographics
NPI:1720386071
Name:MCMAHAND, CRYSTAL RENEE
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:RENEE
Last Name:MCMAHAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:RENEE
Other - Last Name:HANSARD, BENOUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7059 SAN MIGUEL AVE
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-2102
Mailing Address - Country:US
Mailing Address - Phone:619-589-8296
Mailing Address - Fax:
Practice Address - Street 1:7059 SAN MIGUEL AVE
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-2102
Practice Address - Country:US
Practice Address - Phone:619-589-8296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health