Provider Demographics
NPI:1003062480
Name:CREW, BRENDA KAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:KAY
Last Name:CREW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 GARY ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3503
Mailing Address - Country:US
Mailing Address - Phone:228-832-4495
Mailing Address - Fax:228-832-4495
Practice Address - Street 1:127 GARY ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3503
Practice Address - Country:US
Practice Address - Phone:228-832-4495
Practice Address - Fax:228-832-4495
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-17
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC1889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health