Provider Demographics
NPI:1295572634
Name:TERRY, CRYSTAL HOWARD (RBT)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:HOWARD
Last Name:TERRY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 N JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-4739
Mailing Address - Country:US
Mailing Address - Phone:678-899-2608
Mailing Address - Fax:
Practice Address - Street 1:168 N JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-4739
Practice Address - Country:US
Practice Address - Phone:678-899-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician