Provider Demographics
NPI:1821588112
Name:FUJII, KRYSTAL (LPC, RBT)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:
Last Name:FUJII
Suffix:
Gender:F
Credentials:LPC, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 HOLIDAY LN
Mailing Address - Street 2:
Mailing Address - City:HAINESVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-3194
Mailing Address - Country:US
Mailing Address - Phone:773-317-7483
Mailing Address - Fax:
Practice Address - Street 1:243 HOLIDAY LN
Practice Address - Street 2:
Practice Address - City:HAINESVILLE
Practice Address - State:IL
Practice Address - Zip Code:60073-3194
Practice Address - Country:US
Practice Address - Phone:773-317-7483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-13
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011306101Y00000X
IL17-34258106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician