Provider Demographics
NPI:1801455415
Name:ARRIOLA, CRYSTAL ROSE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ROSE
Last Name:ARRIOLA
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 1:2200 DENNISON STREET
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75212
Mailing Address - Country:US
Mailing Address - Phone:972-502-4040
Mailing Address - Fax:214-266-2296
Practice Address - Street 1:2200 DENNISON STREET
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212
Practice Address - Country:US
Practice Address - Phone:972-502-4040
Practice Address - Fax:214-266-2296
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202271OtherLMFT