Provider Demographics
NPI:1285786244
Name:BOOTH, CRYSTAL LYNN (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LYNN
Last Name:BOOTH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 SILVER LEAF CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-1971
Mailing Address - Country:US
Mailing Address - Phone:610-489-6545
Mailing Address - Fax:
Practice Address - Street 1:1976 E HIGH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3277
Practice Address - Country:US
Practice Address - Phone:610-326-1610
Practice Address - Fax:610-326-3104
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004294101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2785696000OtherIBC MHS PROVIDER NUMBER