Provider Demographics
NPI:1891061909
Name:PASCIAK, CRYSTAL R (MS, LPC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:R
Last Name:PASCIAK
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 CEDAR KEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1825
Mailing Address - Country:US
Mailing Address - Phone:248-320-2463
Mailing Address - Fax:
Practice Address - Street 1:3604 CLARKSTON RD STE 102
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-5215
Practice Address - Country:US
Practice Address - Phone:248-595-9969
Practice Address - Fax:248-814-0361
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012973101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIXX19153OtherHEALTHPLUS
MI018954OtherMIDWEST HEALTH PLAN
MI750910681OtherBCTR
MI750910681OtherBCOOS
MI000260F7OtherHAP
MI750910681OtherBCBSFED
MI750910681OtherBCMI
MI750910681OtherBCCHRYSLER