Provider Demographics
NPI:1861573172
Name:MAYER, KRYSCLIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRYSCLIE
Middle Name:
Last Name:MAYER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2099 N COLLINS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2698
Mailing Address - Country:US
Mailing Address - Phone:972-437-4698
Mailing Address - Fax:972-671-2087
Practice Address - Street 1:4401 ATLANTIC AVE
Practice Address - Street 2:SUITE 430
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2218
Practice Address - Country:US
Practice Address - Phone:562-428-3266
Practice Address - Fax:562-428-3288
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17317103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist