Provider Demographics
NPI:1912384975
Name:LANTRIP, CRYSTAL (PHD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:LANTRIP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8009 CHERVIL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8917
Mailing Address - Country:US
Mailing Address - Phone:512-270-0511
Mailing Address - Fax:512-655-9597
Practice Address - Street 1:7000 N MOPAC EXPY STE 2127
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2689
Practice Address - Country:US
Practice Address - Phone:512-270-0511
Practice Address - Fax:512-655-9597
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX36801103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist