Basic Information
| Provider Information | |||||||||
| NPI: | 1225409733 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BINGHAM | ||||||||
| FirstName: | CRYSTAL | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 N BEECH ST | ||||||||
| Address2: | PREVENTIVE MEASURES PROGRAMS | ||||||||
| City: | TALLULAH | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712823809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185740098 | ||||||||
| FaxNumber: | 3185740066 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 N BEECH ST | ||||||||
| Address2: | PREVENTIVE MEASURES PROGRAMS | ||||||||
| City: | TALLULAH | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712823809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185740098 | ||||||||
| FaxNumber: | 3185740066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2015 | ||||||||
| LastUpdateDate: | 10/09/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.