Provider Demographics
NPI:1780064048
Name:HALL, CRYSTAL ANNE (LMHC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANNE
Last Name:HALL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1678
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668-1678
Mailing Address - Country:US
Mailing Address - Phone:360-524-7924
Mailing Address - Fax:
Practice Address - Street 1:329 NE LECHNER ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2445
Practice Address - Country:US
Practice Address - Phone:360-524-7924
Practice Address - Fax:360-836-5836
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60732513101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health