Provider Demographics
NPI:1649011776
Name:WILLIS, CRYSTAL ANNETTE (MHA)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:ANNETTE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21510 COZY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5664
Mailing Address - Country:US
Mailing Address - Phone:832-888-1547
Mailing Address - Fax:
Practice Address - Street 1:21510 COZY HOLLOW LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5664
Practice Address - Country:US
Practice Address - Phone:832-888-1547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty