Individual provider · Type 1 NPI
Crystal Ann Nystrom, LCPC
Professional Counselor · Lewiston, ID
NPI number
1124592365
Active
Practice location
2335 Main St
Lewiston, ID 83501-3242
Fax (208) 743-1170
Mailing address
2901 Meadowlark Dr
Lewiston, ID 83501-9668
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Counselor | 101YM0800X | 60098856 (WA) |
| Professional Counselor Primary | 101YP2500X | 5700 (ID) |
Professional Counselor: Definition to come...
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About NPI 1124592365
Crystal Ann Nystrom, LCPC's National Provider Identifier is 1124592365, issued on Jan 21, 2019. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Lewiston, ID. The record was last updated on Jan 21, 2019.