Crystal Emily Mack, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

317705 Issued in AZ

Practice address

19099 E Walnut CT
Queen Creek, AZ 85142-2436

Phone

(480) 278-6650

NPI assigned

Dec 26, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Redemption Psychiatry, LLC

  • Child & Adolescent Psychiatry Physician
  • Gilbert, AZ
  • NPI 1053757278
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1735171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738281600000",
    "number": "1942018775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19099 E WALNUT CT",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851422436",
            "telephone_number": "480-278-6650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19099 E WALNUT CT",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851422436",
            "telephone_number": "480-278-6650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "CRYSTAL",
        "middle_name": "EMILY",
        "name_prefix": "Mrs.",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-26",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "317705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luxottica of America Inc (Target Optical # Q377)
• Luxottica of America Inc (Target Optical #C4445)
• Lydian Dental Queen Creek, LLC
• M2D Pharmacy, LLC (Four Corners Pharmacy)
• Alex Keith Macdonald
• Joshua Mack, REGISTERED NURSE
• Kelsey Madden, FNP
• Cassie Maddigan
• Roselyn Agulto Maglanoc, FNP
• Lindsay Marie Mahar

• Psychiatric/Mental Health Nurse Practitioner in Queen Creek, AZ
• Providers in Queen Creek, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.