Provider Demographics
NPI:1841745957
Name:DE KAM, CRYSTAL ERIKA-KROELLS (LPCC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ERIKA-KROELLS
Last Name:DE KAM
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:ERIKA
Other - Last Name:KROELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:3300 CENTURY AVE N
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-1842
Mailing Address - Country:US
Mailing Address - Phone:651-779-3313
Mailing Address - Fax:
Practice Address - Street 1:3300 CENTURY AVE N
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-1842
Practice Address - Country:US
Practice Address - Phone:651-779-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01088101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional