Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1093962748 |
---|---|
Provider Name | Mrs. Eleanor Lynn Crysdale |
First Address | Paradise, CA 95967-1476 |
Second Address | Paradise, CA 95969-3280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2008 |
Last Update Date | 25/08/2008 |