Provider Demographics
NPI:1891214938
Name:MEDLIN, CRYSTAL (MA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:CRYSTAL
Other - Middle Name:S
Other - Last Name:MEDLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JENKINS
Mailing Address - Street 1:500 ALA MOANA BLVD STE 7-400
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 ALA MOANA BLVD STE 7-400
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4902
Practice Address - Country:US
Practice Address - Phone:808-557-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-10
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst