Provider Demographics
NPI:1073700829
Name:REESE-CROCKETT, JUDY M
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:M
Last Name:REESE-CROCKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 W VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-5804
Mailing Address - Country:US
Mailing Address - Phone:323-384-4589
Mailing Address - Fax:310-868-5397
Practice Address - Street 1:1085 W VICTORIA ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-5804
Practice Address - Country:US
Practice Address - Phone:323-384-4589
Practice Address - Fax:310-868-5397
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health