Crystal Black, RBT
Individual provider Active NPI Behavior Analyst · Picayune, MS
NPI 1336916733 · NPPES record last updated Dec 6, 2023
Key facts
- NPI
- 1336916733
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- 23-311832 (MS)
- Practice address
- 2007 Wildwood Dr
Picayune, MS 39466-2178 - Phone
- (601) 447-4658
- NPI assigned
- Dec 6, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23-311832 | MS | MD | Behavioral Analyst |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 23-311832 | MS | Yes |
Addresses
Primary practice location
2007 Wildwood Dr
Picayune, MS 39466-2178
Mailing address
144 Hickory RDG
Picayune, MS 39466-9234
Phone (601) 347-4775
Other providers in Picayune, MS
- Casey Bauer
- Bayou Kat Consultants, LLC
- Bedford Care Center-Warren Hall, LLC
- Chinell Bell
- Leah Bell
- Lori L Blackmer
- James J Blount III
- Julie D Bogdan
- Dewitt L Bolton
- Deslie Bonano
All providers in Picayune, MS · Behavior Analyst in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.