Provider Demographics
NPI:1750912382
Name:SALOMON, KHRYSTAL LYNN
Entity type:Individual
Prefix:
First Name:KHRYSTAL
Middle Name:LYNN
Last Name:SALOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 DESERT HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-7733
Mailing Address - Country:US
Mailing Address - Phone:720-318-6075
Mailing Address - Fax:
Practice Address - Street 1:2575 DESERT HILLS DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-7733
Practice Address - Country:US
Practice Address - Phone:720-318-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst