Provider Demographics
NPI:1366997124
Name:GLEASON, KRYSTAL MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:MARIE
Last Name:GLEASON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4583
Mailing Address - Country:US
Mailing Address - Phone:518-338-3117
Mailing Address - Fax:518-831-5944
Practice Address - Street 1:3 WARREN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4583
Practice Address - Country:US
Practice Address - Phone:518-338-3117
Practice Address - Fax:518-831-5944
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY007160101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty