Provider Demographics
NPI:1356786768
Name:ETUK, CRYSTAL DONSHELL
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DONSHELL
Last Name:ETUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:DONSHELL
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4107 TRES SABORES LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-0046
Mailing Address - Country:US
Mailing Address - Phone:832-353-7695
Mailing Address - Fax:
Practice Address - Street 1:5598 NORTH FWY STE A-1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4702
Practice Address - Country:US
Practice Address - Phone:832-353-7695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104783104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker