Crystal Raye Baker, LPC

Individual provider Active NPI Professional Counselor · Fayetteville, AR

NPI 1487843967 · NPPES record last updated Aug 1, 2016

Key facts

NPI
1487843967
Entity type
Individual (NPI type 1)
Primary specialty
Professional Counselor 101YP2500X
License
P012077 (AR)
Practice address
60 W Sunbridge Dr
Fayetteville, AR 72703-1822
Phone
(479) 695-1240
Fax
(479) 750-4843
NPI assigned
Oct 19, 2007
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
P012077ARMDProfessional Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X P012077 AR Yes

Addresses

Primary practice location

60 W Sunbridge Dr
Fayetteville, AR 72703-1822

Mailing address

2400 S 48TH St
Springdale, AR 72762-6683
Phone (479) 750-2020

Other names

  • Crystal Kallenbach and Sexton Former name

Other providers in Fayetteville, AR

All providers in Fayetteville, AR · Professional Counselor in Arkansas

Sources for this page

Verify at the official NPI Registry.