| Doctor Name: | JOHN PALMER CRUM |
| NPI Number: | 1245431022 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCPC, LPC |
| License Number: | 180004715 |
| Business Practice Address: | 95 N Research Dr Ste 110 Edwardsville, IL - 620253604 |
| Business Phone Number: | 6186926880 |
| Business Fax Number: | 3146673108 |
| Mailing Address: | 95 N Research Dr Ste 110, EDWARDSVILLE |
| State: | IL |
| Postal Code: | 620253604 |
| Phone Number: | 6186926880 |
| Fax Number: | 3146673108 |
| NPI Enumeration Date: | 05/30/2007 |
| NPI Last Update Date: | 09/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 180004715 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |