Provider Demographics
NPI:1285108704
Name:CHAN, CHRYSTAL (LMFT, PPS)
Entity type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:LMFT, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E HUNTINGTON DR STE E
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1054
Mailing Address - Country:US
Mailing Address - Phone:626-888-2203
Mailing Address - Fax:
Practice Address - Street 1:118 E HUNTINGTON DR STE E
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-1054
Practice Address - Country:US
Practice Address - Phone:626-888-2203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
CA91138106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool