Provider Demographics
NPI:1720437288
Name:TRAMMELL, CRYSTAL (ASW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:TRAMMELL
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:BOARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30450 HAUN RD # 1094
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-6810
Mailing Address - Country:US
Mailing Address - Phone:760-529-2439
Mailing Address - Fax:
Practice Address - Street 1:30450 HAUN RD # 1094
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-6810
Practice Address - Country:US
Practice Address - Phone:760-529-2439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW957691041C0700X
171M00000X
CAR1245240317101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator