Provider Demographics
NPI:1053744409
Name:LONGANECKER, CRYSTAL LYNN (MA, MFT, LPC)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LYNN
Last Name:LONGANECKER
Suffix:
Gender:F
Credentials:MA, MFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 CORPORATE LN
Mailing Address - Street 2:
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632-8905
Mailing Address - Country:US
Mailing Address - Phone:412-639-9570
Mailing Address - Fax:724-704-8164
Practice Address - Street 1:1056 CORPORATE LN
Practice Address - Street 2:
Practice Address - City:EXPORT
Practice Address - State:PA
Practice Address - Zip Code:15632-8905
Practice Address - Country:US
Practice Address - Phone:412-639-9570
Practice Address - Fax:724-704-8164
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007079101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional