Active NPI
Crystal Vatza, LPC
- Professional Counselor
- Kunkletown, PA
National Provider Identifier
1235508599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PC008166
- Practice address
- 464 Silver Spring Blvd
Kunkletown, PA 18058-7105 - Phone
- (570) 718-8255
- NPI assigned
- Sep 16, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC008166 | PA | Primary |
Addresses
Primary practice location
464 Silver Spring Blvd
Kunkletown, PA 18058-7105
Mailing address
PO Box 556
Mount Pocono, PA 18344-0556
Phone (570) 718-8255
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 15, 2024 through Mar 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC008166 | PA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Light of Life Counseling Services, LLC | Professional | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Professional Counselor
- Tobyhanna, PA
- NPI 1316316672
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685404800000",
"number": "1235508599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 556",
"city": "MOUNT POCONO",
"state": "PA",
"postal_code": "183440556",
"telephone_number": "570-718-8255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "464 SILVER SPRING BLVD",
"city": "KUNKLETOWN",
"state": "PA",
"postal_code": "180587105",
"telephone_number": "570-718-8255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VATZA",
"first_name": "CRYSTAL",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-16",
"last_updated": "2023-05-30",
"certification_date": "2023-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC008166",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kunkletown, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.