Provider Demographics
NPI:1245080977
Name:CARROWAY, CRYSTAL CELESTA (SSP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:CELESTA
Last Name:CARROWAY
Suffix:
Gender:F
Credentials:SSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 MILL PARK LN
Mailing Address - Street 2:
Mailing Address - City:ELM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72762-3107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:277 MILL PARK LN
Practice Address - Street 2:
Practice Address - City:ELM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72762-3107
Practice Address - Country:US
Practice Address - Phone:318-678-9301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool