Provider Demographics
NPI:1275003246
Name:VALDEZ, CRYSTAL LAUREN (LPC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LAUREN
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LAUREN
Other - Last Name:HIBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 2516
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83206-2516
Mailing Address - Country:US
Mailing Address - Phone:208-252-5621
Mailing Address - Fax:208-648-4167
Practice Address - Street 1:476 HERITAGE PARK BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5636
Practice Address - Country:US
Practice Address - Phone:801-896-5345
Practice Address - Fax:801-896-5334
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10837203-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT260022408OtherRAILROAD MEDICARE
UT000055266OtherMEDICARE PIN
UT8760003008007Medicaid