Provider Demographics
NPI:1750821039
Name:BORDERS, CRYSTAL GAIL (LPN, LCDC III)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:GAIL
Last Name:BORDERS
Suffix:
Gender:F
Credentials:LPN, LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 FINDLAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4148
Mailing Address - Country:US
Mailing Address - Phone:740-354-3829
Mailing Address - Fax:740-353-3083
Practice Address - Street 1:411 COURT ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3932
Practice Address - Country:US
Practice Address - Phone:740-354-3829
Practice Address - Fax:740-353-3083
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150837.MEDS-IV164W00000X
OHLCDCIII.161510101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No164W00000XNursing Service ProvidersLicensed Practical Nurse