| C Crystal Psych | |
|
2810 Mack Rd Fairfield OH 45014-5130 | |
| (314) 308-7772 | |
| (314) 308-7772 |
| Full Name | C Crystal Psych |
|---|---|
| Speciality | Psychologist |
| Location | 2810 Mack Rd, Fairfield, Ohio |
| Authorized Official Name and Position | Chana D Crystal (OWNER) |
| Authorized Official Contact | 3143087772 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| C Crystal Psych 2810 Mack Rd Fairfield OH 45014-5130 Ph: () - | C Crystal Psych 2810 Mack Rd Fairfield OH 45014-5130 Ph: (314) 308-7772 |
| NPI Number | 1750818225 |
|---|---|
| Provider Enumeration Date | 05/16/2017 |
| Last Update Date | 05/16/2017 |
| Medicare PECOS PAC ID | 4486997467 |
|---|---|
| Medicare Enrollment ID | O20190514002268 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750818225 | NPI | - | NPPES |
| Provider Name | Chana Crystal |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407355266 PECOS PAC ID: 4880938018 Enrollment ID: I20181129000688 |
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