Provider Demographics
NPI:1265209928
Name:RUMLER, CRYSTAL R (LMSW)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:R
Last Name:RUMLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:R
Other - Last Name:ELWESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13821 FREEPORT RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3206
Mailing Address - Country:US
Mailing Address - Phone:360-710-1597
Mailing Address - Fax:
Practice Address - Street 1:13821 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-3206
Practice Address - Country:US
Practice Address - Phone:360-710-1597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0903002240104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker