Provider Demographics
NPI:1902342363
Name:PYLES, CRYSTAL M (LSW)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:M
Last Name:PYLES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 ARMSTRONG ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-1800
Mailing Address - Country:US
Mailing Address - Phone:419-394-7451
Mailing Address - Fax:
Practice Address - Street 1:720 ARMSTRONG ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885
Practice Address - Country:US
Practice Address - Phone:419-394-7451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2847496Medicaid