Provider Demographics
NPI:1336419159
Name:TARVER, KRYSTAL JOY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:JOY
Last Name:TARVER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KRYSTAL
Other - Middle Name:JOY
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:14015 ROBBIE CREEK LN.
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396
Mailing Address - Country:US
Mailing Address - Phone:832-492-8250
Mailing Address - Fax:
Practice Address - Street 1:20031 W LAKE HOUSTON PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3432
Practice Address - Country:US
Practice Address - Phone:832-492-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66619101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health