Provider Demographics
NPI:1104298181
Name:TAPIA, CRYSTAL MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:MARIE
Last Name:TAPIA
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 1:2001 E LOHMAN AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3197
Mailing Address - Country:US
Mailing Address - Phone:575-520-0887
Mailing Address - Fax:575-524-4813
Practice Address - Street 1:2001 E LOHMAN AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3197
Practice Address - Country:US
Practice Address - Phone:575-520-0887
Practice Address - Fax:575-524-4813
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-081561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical