Provider Demographics
NPI:1154874477
Name:WILLIAMS, CRYSTAL L (PLMFT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 S IBERIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-7206
Mailing Address - Country:US
Mailing Address - Phone:337-519-6055
Mailing Address - Fax:
Practice Address - Street 1:19157 CROWLEY EUNICE HWY
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-0801
Practice Address - Country:US
Practice Address - Phone:337-514-2101
Practice Address - Fax:337-514-2105
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1494106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600720410Medicaid