Provider Demographics
NPI:1730693920
Name:BARD, CRYSTAL GAIL
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:GAIL
Last Name:BARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:GAIL
Other - Last Name:LAPRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:65 TINKERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:VA
Mailing Address - Zip Code:24077-3009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 TINKERVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:VA
Practice Address - Zip Code:24077
Practice Address - Country:US
Practice Address - Phone:540-597-7810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician