Provider Demographics
NPI:1063753093
Name:GRAYSON, CRYSTAL (LCSW)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W PLUMB LN STE 1A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3691
Mailing Address - Country:US
Mailing Address - Phone:775-322-4666
Mailing Address - Fax:775-322-4747
Practice Address - Street 1:540 W PLUMB LN STE 1A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3691
Practice Address - Country:US
Practice Address - Phone:775-322-4666
Practice Address - Fax:775-322-4747
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2691-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical