Doctor Name: | AMANDA CRABTREE |
NPI Number: | 1265799415 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PLPC |
License Number: | 2011036951 |
Business Practice Address: | 413 E Spring St Boonville, MO - 652331573 |
Business Phone Number: | 6608826400 |
Business Fax Number: | |
Mailing Address: | 16801 N Edgeview Rd, CENTRALIA |
State: | MO |
Postal Code: | 652403741 |
Phone Number: | 5736960661 |
Fax Number: | |
NPI Enumeration Date: | 04/12/2012 |
NPI Last Update Date: | 04/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2011036951 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |