Provider Demographics
NPI:1770722886
Name:CLUNE, CRYSTAL LEAH (LMFT 139013)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEAH
Last Name:CLUNE
Suffix:
Gender:F
Credentials:LMFT 139013
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13010 DAISY BLUE MINE RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9708
Mailing Address - Country:US
Mailing Address - Phone:530-575-6120
Mailing Address - Fax:
Practice Address - Street 1:412 E MAIN ST STE J
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6533
Practice Address - Country:US
Practice Address - Phone:530-575-6120
Practice Address - Fax:530-575-6120
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
CAIMF62333106H00000X
CA139013106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health