Provider Demographics
NPI:1972782258
Name:DURDEN, CRYSTAL (MFT)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:DURDEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 SILVERADO ST
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4524
Mailing Address - Country:US
Mailing Address - Phone:619-777-9254
Mailing Address - Fax:
Practice Address - Street 1:1150 SILVERADO ST
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4524
Practice Address - Country:US
Practice Address - Phone:619-777-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist