Provider Demographics
NPI:1790179307
Name:CONTRERAS, CRYSTAL YVONNE (LMSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:YVONNE
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 BLACKTAIL DEER AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-5220
Mailing Address - Country:US
Mailing Address - Phone:575-526-9878
Mailing Address - Fax:575-526-7835
Practice Address - Street 1:121 WYATT DR STE 7
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2960
Practice Address - Country:US
Practice Address - Phone:575-526-9878
Practice Address - Fax:575-526-7835
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-098801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18677037Medicaid