Provider Demographics
NPI:1851174601
Name:FERREE, CRYSTAL D (RBT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:FERREE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:D
Other - Last Name:GIBBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1501 W TAPP RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-3459
Mailing Address - Country:US
Mailing Address - Phone:812-330-4460
Mailing Address - Fax:
Practice Address - Street 1:1501 W TAPP RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-3459
Practice Address - Country:US
Practice Address - Phone:812-330-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-23-291338106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician