Active NPI
Crystle Prung, PH.D.
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1437525524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY31568
- Practice address
- 7000 Romaine St Ste 207
Los Angeles, CA 90038-2304 - Phone
- (213) 465-0667
- NPI assigned
- Aug 12, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY31568 | CA | Primary |
Addresses
Primary practice location
7000 Romaine St Ste 207
Los Angeles, CA 90038-2304
Mailing address
7000 Romaine Street
Suite 207
Los Angeles, CA 90038-7318
Other practice location 1
2110 W Sunset Blvd Ste P
Los Angeles, CA 90026-7318
Phone (213) 465-0667
Other names 1
- Crystle Prung
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY31568 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Silver Lake Psychotherapy PC | Psychologist | Past | Accepting new patients |
| County of Orange | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Santa Ana, CA
- NPI 1689002297
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617667200000",
"number": "1437525524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7000 ROMAINE STREET",
"address_2": "SUITE 207",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900387318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7000 ROMAINE ST STE 207",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900382304",
"telephone_number": "213-465-0667"
}
],
"practiceLocations": [
{
"address_1": "2110 W Sunset Blvd Ste P",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900267318",
"country_code": "US",
"telephone_number": "213-465-0667",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PRUNG",
"first_name": "CRYSTLE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-08-12",
"last_updated": "2021-04-06",
"certification_date": "2021-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY31568",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CRYSTLE",
"last_name": "PRUNG",
"credential": "PH.D.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.