Provider Demographics
NPI:1083913065
Name:ZEHM, CRYSTAL DAWN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:DAWN
Last Name:ZEHM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13600 OTTER CREEK PKWY
Mailing Address - Street 2:APT 204
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5714
Mailing Address - Country:US
Mailing Address - Phone:479-426-3951
Mailing Address - Fax:
Practice Address - Street 1:305 S PALM
Practice Address - Street 2:ARKANSAS STATE HOSPITAL
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-686-9407
Practice Address - Fax:501-686-9298
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2345-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker