Provider Demographics
NPI:1548049521
Name:HARRISON, KRYSTAL MICHELLE
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:MICHELLE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:MICHELLE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15 E SOUTHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4550
Mailing Address - Country:US
Mailing Address - Phone:641-351-4003
Mailing Address - Fax:641-351-4968
Practice Address - Street 1:15 E SOUTHRIDGE RD
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4550
Practice Address - Country:US
Practice Address - Phone:641-351-4003
Practice Address - Fax:641-351-4968
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor