Provider Demographics
NPI:1750829263
Name:CRYSTAL, JENNIFER PAGE (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:PAGE
Last Name:CRYSTAL
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 CAMBOURNE PL
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4102
Mailing Address - Country:US
Mailing Address - Phone:248-331-6003
Mailing Address - Fax:
Practice Address - Street 1:1231 GAMBELL ST STE 300
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-4664
Practice Address - Country:US
Practice Address - Phone:907-333-4343
Practice Address - Fax:907-333-4843
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK229925101YM0800X
MI6401005542101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty