Provider Demographics
NPI:1942785407
Name:THOMPSON, CRYSTALIN RENNEE (LMHCA, SUDP)
Entity type:Individual
Prefix:
First Name:CRYSTALIN
Middle Name:RENNEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMHCA, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 E PIONEER STE B
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3267
Mailing Address - Country:US
Mailing Address - Phone:425-390-4898
Mailing Address - Fax:
Practice Address - Street 1:104 W MAIN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-8904
Practice Address - Country:US
Practice Address - Phone:253-686-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WAMC61571030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO60776673OtherCHEMICAL DEPENDENCY COUNSELOR INTERN
WAMC61571030OtherLMHCA
WACP60940324OtherSUBSTANCE USE DISORDER COUNSELOR