Provider Demographics
NPI:1972643740
Name:CRYSTAL, REBECCA ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:CRYSTAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:JIRAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:804 PECAN GROVE RD E
Mailing Address - Street 2:CHILD AND FAMILY GUIDANCE CENTER
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1767
Mailing Address - Country:US
Mailing Address - Phone:903-893-7768
Mailing Address - Fax:903-893-4979
Practice Address - Street 1:804 PECAN GROVE RD E
Practice Address - Street 2:CHILD AND FAMILY GUIDANCE CENTER
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1767
Practice Address - Country:US
Practice Address - Phone:903-893-7768
Practice Address - Fax:903-893-4979
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX501201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184946501Medicaid