Crystal Ann Nystrom, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5700 Issued in ID

Practice address

2335 Main St
Lewiston, ID 83501-3242

Phone

(208) 791-0129

Fax

(208) 743-1170

NPI assigned

Jan 21, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Valley Treatment Specialties LLC

  • Adult Mental Health Clinic/Center
  • Lewiston, ID
  • NPI 1710666896
  NPD Authorized official
• Changepoint, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Lewiston, ID
  • NPI 1396189957
  NPD (past)

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

{
    "created_epoch": "1548028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548028800000",
    "number": "1124592365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 MEADOWLARK DR",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835019668",
            "telephone_number": "208-791-0129",
            "fax_number": "208-743-1170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2335 MAIN ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835013242",
            "telephone_number": "208-791-0129",
            "fax_number": "208-743-1170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYSTROM",
        "first_name": "CRYSTAL",
        "middle_name": "ANN",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-21",
        "last_updated": "2019-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "60098856",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ID",
            "license": "5700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HPSO LIABILITY INSURANCE",
            "identifier": "0675366780",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northwest Children'S Home
• Jennifer Norton
• Christine L Norwood, FNP
• Joni Lee Nuber, B.A., L.S.W.
• NW Natural Healthcare LLC
• David Nystrom, LCSW
• Obsidain Mental Health, PLLC
• Brenda Lynn Offerdahl, O.D.
• Lawrence C Ohman, PT
• Akinmusuyi Ayodeji Oladiran, PHARMD

• Professional Counselor in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Professional Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.