Provider Demographics
NPI:1275356271
Name:DESHOTEL, CRYSTAL G
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:G
Last Name:DESHOTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3289 OSAGE TRL
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-4762
Mailing Address - Country:US
Mailing Address - Phone:337-427-3879
Mailing Address - Fax:
Practice Address - Street 1:3289 OSAGE TRL
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-4762
Practice Address - Country:US
Practice Address - Phone:337-427-3879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst