Provider Demographics
NPI:1982597837
Name:PORTIS, CRYSTAL (LMSW)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:PORTIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 FONDREN RD APT 228
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-5688
Mailing Address - Country:US
Mailing Address - Phone:314-922-3577
Mailing Address - Fax:
Practice Address - Street 1:10700 FONDREN RD APT 228
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-5688
Practice Address - Country:US
Practice Address - Phone:314-922-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111189104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty