Crystal Wellness Center Inc

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

CRYSTAL WELLNESS CENTER INC

Practice address

6609 Blanco Rd Ste 335
San Antonio, TX 78216-4504

Phone

(210) 455-1779

Fax

(210) 802-4698

NPI assigned

Feb 1, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Lawrence MackNPI 1992936124

Title

Owner

Phone

(210) 802-4695

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lawrence C. Mack Jr., LPC

  • Professional Counselor
  • San Antonio, TX
  • NPI 1992936124
  NPD Authorized official
• Violet Dakora, NURSE PRACTITIONER

  • Nurse Practitioner
  • San Antonio, TX
  • NPI 1831557982
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1124583349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 GALLERY CIR STE 201",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583341",
            "telephone_number": "210-802-4695",
            "fax_number": "210-802-4698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6609 BLANCO RD STE 335",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782164504",
            "telephone_number": "210-455-1779",
            "fax_number": "210-802-4698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "116 Gallery Cir Ste 201",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782583341",
            "country_code": "US",
            "telephone_number": "210-802-4695",
            "fax_number": "210-802-4698",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CRYSTAL WELLNESS CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-01",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-802-4695",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cryo Body Shape
• Cryst Care Homes LLC
• Crystal Clear Dental
• Crystal Counseling PLLC
• Crystal Counseling, PLLC
• CSC Houston West, Inc
• Csdmd PLLC
• Abigail Grace Csengery, LPC-ASSOCIATE
• Csfa Gonzalez
• CSH San Antonio LP

• Nurse Practitioner in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.