Provider Demographics
NPI:1851991640
Name:STEWART, CRYSTAL LEE (MA, LLPC, CBIS)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LEE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MA, LLPC, CBIS
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LEE
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36991 GREENBUSH RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1128
Mailing Address - Country:US
Mailing Address - Phone:734-657-0046
Mailing Address - Fax:
Practice Address - Street 1:20500 EUREKA RD STE 200
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6394
Practice Address - Country:US
Practice Address - Phone:734-285-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018658101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor