Most Relevant Information
Provider Data
| NPI Number: | 1003635376 |
| Provider Name: | KRYSTAL LIGHT LEDDY PSYD |
| Entity Type: | Individual |
| Taxonomy Code: | 103TC0700X |
| Specialty: | Psychologist |
| License Number: | 0810008655 |
Most Important Dates
| Enumeration Date: | 10/04/2024 |
| Last Updated: | 10/04/2024 |
Provider Practice Location
249 CENTRAL PARK AVE STE 300
VIRGINIA BEACH
VA
234623271
Practice Location Phone/Fax
| Phone: | 7572316343 |
| Fax: |
Provider Mailing Location
2176 S TERRACE DR
WICHITA
KS
672185046
Provider Mailing Phone/Fax
| Phone: | 3167445354 |
| Fax: |