Provider Demographics
NPI:1588923304
Name:CRYSTAL COUNSELING PLLC
Entity type:Organization
Organization Name:CRYSTAL COUNSELING PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:210-998-5591
Mailing Address - Street 1:18756 STONE OAK PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4790
Mailing Address - Country:US
Mailing Address - Phone:210-998-5591
Mailing Address - Fax:210-579-1516
Practice Address - Street 1:116 GALLERY CIR STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3341
Practice Address - Country:US
Practice Address - Phone:210-998-5591
Practice Address - Fax:210-579-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health