Provider Demographics
NPI:1922985993
Name:CROCKETT, CRYSTAL (BCBA)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18020 CRIMSON APPLE WAY
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2554
Mailing Address - Country:US
Mailing Address - Phone:317-213-0637
Mailing Address - Fax:
Practice Address - Street 1:18020 CRIMSON APPLE WAY
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2554
Practice Address - Country:US
Practice Address - Phone:317-213-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-22-61223103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty