Provider Demographics
NPI:1548663388
Name:MURRELL, CRYSTAL (PCC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MURRELL
Suffix:
Gender:M
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 EUCLID AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3135 EUCLID AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2531
Practice Address - Country:US
Practice Address - Phone:216-391-2064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDC.131219-3101YA0400X
OHE. 1000193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)