Provider Demographics
NPI:1063445336
Name:CRUMP-CAMPAGNOLI, GENEELE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GENEELE
Middle Name:
Last Name:CRUMP-CAMPAGNOLI
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 1:59216 MERRIMAC LN
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-3415
Mailing Address - Country:US
Mailing Address - Phone:574-875-6399
Mailing Address - Fax:574-875-4184
Practice Address - Street 1:59216 MERRIMAC LN
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-3415
Practice Address - Country:US
Practice Address - Phone:574-875-6399
Practice Address - Fax:574-875-4184
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000669A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health