C Crystal Psych

NPI #1750818225 in Fairfield, Ohio

Provider Information

NPI Number: 1750818225
Entity Type: Organization
Organization Name: C Crystal Psych
Primary Specialty: Psychologist
Enumeration Date: May 16, 2017
Last Updated: May 16, 2017

Practice Location

Address: 2810 MACK RD
City: Fairfield
State: Ohio
ZIP Code: 45014-5130
Phone: (314) 308-7772

Authorized Official

Name: DR. CHANA D CRYSTAL, PSYD, EDS
Title: OWNER
Phone: (314) 308-7772

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical Child & Adolescent — Clinical Child & Adolescent	103TC2200X
Psychologist - Intellectual & Developmental Disabilities — Intellectual & Developmental Disabilities	103TM1800X
Psychologist - School — School	103TS0200X
Psychologist	103T00000X	Primary

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