| NPI | 1962174730 |
|---|---|
| Former Name | CRYSTAL ANN MELZOW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 42324) |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2021-12-22 |