Provider Demographics
NPI:1548724404
Name:JEFFREY, CRYSTAL ALEXIA (LCDC)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:ALEXIA
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16714 SIDONIE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-2562
Mailing Address - Country:US
Mailing Address - Phone:832-721-3005
Mailing Address - Fax:
Practice Address - Street 1:6201 BONHOMME RD STE 174N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4367
Practice Address - Country:US
Practice Address - Phone:832-864-3347
Practice Address - Fax:833-241-7558
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TX13042101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator