Provider Demographics
NPI:1861607012
Name:MCLEOD, CRYSTAL PRIMEAU (MA, LLP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:PRIMEAU
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1413
Mailing Address - Country:US
Mailing Address - Phone:906-370-4701
Mailing Address - Fax:906-487-3421
Practice Address - Street 1:400 EMERALD ST
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1413
Practice Address - Country:US
Practice Address - Phone:906-370-4701
Practice Address - Fax:906-487-3421
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013944103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical