Provider Demographics
NPI:1437689338
Name:SMITH, KRYSTAL (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 STEAMBOAT PKWY UNIT 7105
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-6373
Mailing Address - Country:US
Mailing Address - Phone:248-885-9027
Mailing Address - Fax:
Practice Address - Street 1:1818 S STATE COLLEGE BLVD UNIT 321
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-8913
Practice Address - Country:US
Practice Address - Phone:775-298-1362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34381103TC0700X
NVPY1151103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical