Provider Demographics
NPI:1336711910
Name:MYATT-JONES, CRYSTAL ELAINE
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ELAINE
Last Name:MYATT-JONES
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 1:206 DOUBLETREE LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-2005
Mailing Address - Country:US
Mailing Address - Phone:313-721-6620
Mailing Address - Fax:
Practice Address - Street 1:1404 E AVALON AVE
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-1773
Practice Address - Country:US
Practice Address - Phone:256-381-5507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3801A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health