Provider Demographics
NPI:1649660994
Name:BELLABY, CRYSTAL ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANNE
Last Name:BELLABY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2242 S WHIPPLE ST
Mailing Address - Street 2:3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3775
Mailing Address - Country:US
Mailing Address - Phone:773-290-7586
Mailing Address - Fax:773-989-1935
Practice Address - Street 1:2242 S WHIPPLE ST
Practice Address - Street 2:3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3775
Practice Address - Country:US
Practice Address - Phone:773-290-7586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0172521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical