| NPI | 1356581227 |
|---|---|
| Former Name | CRYSTAL ANN BOSTOW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ND 621-12-15-08) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1596) |
| Enumeration Date | 2009-03-04 |
| Last Update Date | 2021-12-03 |