Provider Demographics
NPI:1801101167
Name:POULTON-MERCER, CRYSTAL ALICIA (MA, LPC, LMFT)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:ALICIA
Last Name:POULTON-MERCER
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 N. JOSEY LANE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006
Mailing Address - Country:US
Mailing Address - Phone:214-789-9318
Mailing Address - Fax:
Practice Address - Street 1:2625 N. JOSEY LANE
Practice Address - Street 2:SUITE 250
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006
Practice Address - Country:US
Practice Address - Phone:214-789-9318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63743101YP2500X
TX201243106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional