Provider Demographics
NPI:1740732213
Name:GUTH, CRYSTAL WOIDYLA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:WOIDYLA
Last Name:GUTH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SAN NICOLAS CIR
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-3041
Mailing Address - Country:US
Mailing Address - Phone:805-914-8776
Mailing Address - Fax:
Practice Address - Street 1:100 E THOUSAND OAKS BLVD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5713
Practice Address - Country:US
Practice Address - Phone:805-914-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT91264106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist