Provider Demographics
NPI:1528344629
Name:KENDALL, CRYSTAL DENISE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DENISE
Last Name:KENDALL
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 1:22030 SHERMAN WAY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1855
Mailing Address - Country:US
Mailing Address - Phone:818-714-6714
Mailing Address - Fax:818-206-3376
Practice Address - Street 1:22030 SHERMAN WAY
Practice Address - Street 2:SUITE 115
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1855
Practice Address - Country:US
Practice Address - Phone:818-714-6714
Practice Address - Fax:818-206-3376
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)