Provider Demographics
NPI:1245533793
Name:PUGH, CRYSTAL LEA
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LEA
Last Name:PUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CRYSTAL
Other - Middle Name:LEA
Other - Last Name:BREWINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12805 LIMESTONE DR
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-4153
Mailing Address - Country:US
Mailing Address - Phone:479-926-6912
Mailing Address - Fax:
Practice Address - Street 1:1016 E SHAWNTEL SMITH BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:MULDROW
Practice Address - State:OK
Practice Address - Zip Code:74948-4823
Practice Address - Country:US
Practice Address - Phone:479-926-6912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst