Provider Demographics
NPI:1962174730
Name:LUVAUL, CRYSTAL ANN (LCDC-I)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANN
Last Name:LUVAUL
Suffix:
Gender:F
Credentials:LCDC-I
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:ANN
Other - Last Name:MELZOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2476
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77588-2476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:365 N SHIRLEY ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-5631
Practice Address - Country:US
Practice Address - Phone:832-580-7101
Practice Address - Fax:281-867-6750
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42324101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX42324OtherLCDC-I