Provider Demographics
NPI:1629469192
Name:ANTHONY, CRYSTAL (MS, LPCC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 14TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4644
Mailing Address - Country:US
Mailing Address - Phone:320-202-1400
Mailing Address - Fax:320-202-8662
Practice Address - Street 1:110 14TH AVE E
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4644
Practice Address - Country:US
Practice Address - Phone:320-202-1400
Practice Address - Fax:320-202-8662
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00884101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional