Provider Demographics
NPI:1740624071
Name:HULETT, CRYSTAL NICOLE (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:NICOLE
Last Name:HULETT
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MRS
Other - First Name:CRYSTAL
Other - Middle Name:NICOLE
Other - Last Name:FURMANIUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFTA
Mailing Address - Street 1:305 COMMODORE LOOP
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7417
Mailing Address - Country:US
Mailing Address - Phone:704-756-0058
Mailing Address - Fax:
Practice Address - Street 1:201 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2583
Practice Address - Country:US
Practice Address - Phone:704-660-6854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8041A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist