Provider Demographics
NPI:1801423512
Name:KITCHEN, CRYSTAL SHAY (LPC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:SHAY
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78407-2306
Mailing Address - Country:US
Mailing Address - Phone:361-206-1402
Mailing Address - Fax:
Practice Address - Street 1:400 MANN ST STE 115
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-2046
Practice Address - Country:US
Practice Address - Phone:361-206-1402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health