Provider Demographics
NPI:1144349978
Name:SCOTT, CRYSTAL MARIA (LMFT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARIA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10517 N. MACARTHUR BLVD
Mailing Address - Street 2:#1036
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063
Mailing Address - Country:US
Mailing Address - Phone:209-324-4004
Mailing Address - Fax:972-506-8571
Practice Address - Street 1:10517 N. MACARTHUR BLVD
Practice Address - Street 2:#1036
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063
Practice Address - Country:US
Practice Address - Phone:209-324-4004
Practice Address - Fax:972-506-8571
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201586106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX296010601Medicaid