Provider Demographics
NPI:1720570203
Name:SHIPOS, CRYSTAL M (MS)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:SHIPOS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 DELRIDGE WAY SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1379
Mailing Address - Country:US
Mailing Address - Phone:206-279-0830
Mailing Address - Fax:206-935-9967
Practice Address - Street 1:4555 DELRIDGE WAY SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-1379
Practice Address - Country:US
Practice Address - Phone:206-279-0830
Practice Address - Fax:206-935-9967
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health