Provider Demographics
NPI:1154875730
Name:REEVES, CRYSTAL (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:SHOHATEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1173 FRONT ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3904
Mailing Address - Country:US
Mailing Address - Phone:760-658-4650
Mailing Address - Fax:
Practice Address - Street 1:1173 FRONT ST FL 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3904
Practice Address - Country:US
Practice Address - Phone:760-658-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA93727106H00000X
CA109370106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health