Provider Demographics
NPI:1043405392
Name:CROW, TRUDY SMITH (LCSW)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:SMITH
Last Name:CROW
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 1:207 FRANKIE LN
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-2683
Mailing Address - Country:US
Mailing Address - Phone:870-209-6804
Mailing Address - Fax:
Practice Address - Street 1:207 FRANKIE LN
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-2683
Practice Address - Country:US
Practice Address - Phone:870-209-6804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2500C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116378726Medicaid