Provider Demographics
NPI:1972705911
Name:PITTS, CRYSTAL ANNE (LMFT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANNE
Last Name:PITTS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:MARKLEEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96120-0091
Mailing Address - Country:US
Mailing Address - Phone:530-694-1816
Mailing Address - Fax:
Practice Address - Street 1:40 DIAMOND VALLEY RD
Practice Address - Street 2:
Practice Address - City:MARKLEEVILLE
Practice Address - State:CA
Practice Address - Zip Code:96120-9512
Practice Address - Country:US
Practice Address - Phone:530-694-1816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2735-R106H00000X
CALMFT78392106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist