Provider Demographics
NPI:1477397263
Name:LOZANO, CRYSTAL ROSE YVETTE (LCDC)
Entity type:Individual
Prefix:
First Name:CRYSTAL ROSE
Middle Name:YVETTE
Last Name:LOZANO
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3398 MCGILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76905-4297
Mailing Address - Country:US
Mailing Address - Phone:325-450-9859
Mailing Address - Fax:
Practice Address - Street 1:3398 MCGILL BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76905-4297
Practice Address - Country:US
Practice Address - Phone:325-450-9859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14413101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)