Provider Demographics
NPI:1093782930
Name:CRYE, MICHELLE RUTH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RUTH
Last Name:CRYE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:JAMNIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:506 RICHARDSON ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3430
Mailing Address - Country:US
Mailing Address - Phone:903-677-4800
Mailing Address - Fax:903-677-4803
Practice Address - Street 1:506 RICHARDSON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3430
Practice Address - Country:US
Practice Address - Phone:903-677-4800
Practice Address - Fax:903-677-4803
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14690101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027797201Medicaid