Provider Demographics
NPI:1942640958
Name:STROUD, CRYSTAL (MASTER LEVEL)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:STROUD
Suffix:
Gender:F
Credentials:MASTER LEVEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 PLAYPEN DR
Mailing Address - Street 2:14
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1456
Mailing Address - Country:US
Mailing Address - Phone:904-210-0254
Mailing Address - Fax:
Practice Address - Street 1:1419 UNIVERSITY BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5249
Practice Address - Country:US
Practice Address - Phone:904-547-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health