Provider Demographics
NPI:1194093898
Name:MORGAN-WALLS, CRYSTAL L
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:MORGAN-WALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:L
Other - Last Name:WALLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4711 SE 77TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-4544
Mailing Address - Country:US
Mailing Address - Phone:405-921-3430
Mailing Address - Fax:
Practice Address - Street 1:4711 SE 77TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-4544
Practice Address - Country:US
Practice Address - Phone:405-921-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24196103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst