Provider Demographics
NPI:1104122050
Name:VALERIO-SANDOVAL, CRYSTAL (LMFT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:VALERIO-SANDOVAL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:SANDOVAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20831 MURAL ST
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-5911
Mailing Address - Country:US
Mailing Address - Phone:951-901-6042
Mailing Address - Fax:909-913-4860
Practice Address - Street 1:20831 MURAL ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-5911
Practice Address - Country:US
Practice Address - Phone:951-483-3072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106044106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health