Provider Demographics
NPI:1336799550
Name:LYNN-TOLSON, KRYSTAL KORU (LPC)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:KORU
Last Name:LYNN-TOLSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 888
Mailing Address - Street 2:
Mailing Address - City:GOULDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18424-0888
Mailing Address - Country:US
Mailing Address - Phone:570-877-0820
Mailing Address - Fax:
Practice Address - Street 1:278 PACKANACK DRIVE
Practice Address - Street 2:
Practice Address - City:GOULDSBORO
Practice Address - State:PA
Practice Address - Zip Code:18424
Practice Address - Country:US
Practice Address - Phone:570-877-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82552101YP2500X
PAPC017222101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC017222OtherPENNSYLVANIA STATE BOARD OF PROFESSIONAL COUNSELORS
TX82552OtherTEXAS STATE BOARD OF PROFESSIONAL COUNSELORS