Provider Demographics
NPI:1609173103
Name:SPECHT, CRYSTAL LEE KUYANA (LMHC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEE KUYANA
Last Name:SPECHT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LEE KUYANA
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:15106 S GRANITE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-9668
Mailing Address - Country:US
Mailing Address - Phone:509-720-9417
Mailing Address - Fax:509-467-0344
Practice Address - Street 1:1220 N HOWARD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2410
Practice Address - Country:US
Practice Address - Phone:509-467-7913
Practice Address - Fax:509-467-0344
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60200915101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health