Doctor Name: | MS. JESSICA CRISLIP |
NPI Number: | 1245660786 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, EDS., N.C.S.P. |
License Number: | C2R133700288 |
Business Practice Address: | 102 Smithfield St Buckhannon, WV - 262012620 |
Business Phone Number: | 3046246554 |
Business Fax Number: | 3046245223 |
Mailing Address: | 1201 N 15th St, CLARKSBURG |
State: | WV |
Postal Code: | 263011989 |
Phone Number: | 3046246554 |
Fax Number: | 3046245223 |
NPI Enumeration Date: | 11/20/2013 |
NPI Last Update Date: | 11/20/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | C2R133700288 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |