Provider Demographics
NPI:1750768206
Name:CORONA MENDOZA, CRYSTAL LIZ (LMFT, APCC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LIZ
Last Name:CORONA MENDOZA
Suffix:
Gender:F
Credentials:LMFT, APCC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LIZ
Other - Last Name:CORONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2300 BOSWELL RD STE 245
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3539
Mailing Address - Country:US
Mailing Address - Phone:619-549-0329
Mailing Address - Fax:619-550-3547
Practice Address - Street 1:2300 BOSWELL RD STE 245
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3539
Practice Address - Country:US
Practice Address - Phone:619-549-0329
Practice Address - Fax:619-550-3547
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2905101YP2500X, 101YP2500X
CALMFT119578106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA92834OtherBOARD OF BEHAVIORAL SCIENCES
CA2905OtherBOARD OF BEHAVIORAL SCIENCES