Provider Demographics
NPI:1003904475
Name:CRUTCHFIELD, JIM (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:
Last Name:CRUTCHFIELD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:CRUTCHFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:P.O. BOX 605
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695
Mailing Address - Country:US
Mailing Address - Phone:727-736-3132
Mailing Address - Fax:727-736-3052
Practice Address - Street 1:1613 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-4759
Practice Address - Country:US
Practice Address - Phone:727-736-3132
Practice Address - Fax:727-736-3052
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00047521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical