Provider Demographics
NPI:1124317904
Name:MALY, CRYSTAL A (MSE, LADC, LMHP)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:A
Last Name:MALY
Suffix:
Gender:F
Credentials:MSE, LADC, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 33RD AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1479
Mailing Address - Country:US
Mailing Address - Phone:402-564-3955
Mailing Address - Fax:401-564-3955
Practice Address - Street 1:3050 33RD AVE STE 10
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1479
Practice Address - Country:US
Practice Address - Phone:402-564-3955
Practice Address - Fax:401-564-3955
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE515101YA0400X
NE2238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)