Provider Demographics
NPI:1821489261
Name:WESTBROOK, CHRYSTAL NICOLE (MA LPC)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:NICOLE
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:CHRYSTAL
Other - Middle Name:N
Other - Last Name:OSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:383 TILMOR DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2565
Mailing Address - Country:US
Mailing Address - Phone:248-842-4501
Mailing Address - Fax:
Practice Address - Street 1:383 TILMOR DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2565
Practice Address - Country:US
Practice Address - Phone:248-842-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012818101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional