Crystal M Berthiaume, LMFT
Individual provider Active NPI Marriage & Family Therapist · Lawton, OK
NPI 1417540485 · NPPES record last updated Feb 22, 2021
Key facts
- NPI
- 1417540485
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 1402 (OK)
- Practice address
- 5002 SW Lee Blvd
Lawton, OK 73505-8320 - Phone
- (580) 531-4512
- Fax
- (580) 531-4519
- NPI assigned
- Feb 19, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 9, 2025 through Apr 9, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1402 | OK | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 1402 | OK | Yes |
Addresses
Primary practice location
5002 SW Lee Blvd
Lawton, OK 73505-8320
Mailing address
5002 SW Lee Blvd
Lawton, OK 73505-8320
Phone (580) 531-4512
Other providers in Lawton, OK
- Mercedez Bernard
- Makayla Marie Berry
- Virginia Ann Berry
- Walter Thomas Berry
- Zachary Michael Berry
- Ronna Deanne Bertram-Davis
- Andrew Bevington
- Ajay Bhargava
- Shireen Bhargava
- Lindsey Elaine Bickerstaff
All providers in Lawton, OK · Marriage & Family Therapist in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.