Doctor Name: | LACY CRUMRINE |
NPI Number: | 1659621571 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 49 Rebel Dr. University, MS - 38677 |
Business Phone Number: | 6629157197 |
Business Fax Number: | 6629157230 |
Mailing Address: | P.o.box 1848, School Of Education, Capti UNIVERSITY |
State: | MS |
Postal Code: | 38677 |
Phone Number: | 6629157197 |
Fax Number: | 6629157230 |
NPI Enumeration Date: | 09/18/2012 |
NPI Last Update Date: | 09/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |