Provider Demographics
NPI:1285519785
Name:GONDER, CRYSTAL (A2508010)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:GONDER
Suffix:
Gender:F
Credentials:A2508010
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 JEFFERSON PL
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6931
Mailing Address - Country:US
Mailing Address - Phone:870-872-4249
Mailing Address - Fax:
Practice Address - Street 1:11 JEFFERSON PL
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6931
Practice Address - Country:US
Practice Address - Phone:870-872-4249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2508010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health