Provider Demographics
NPI:1114110129
Name:KRAWCZYN, JOREY (IMH2565)
Entity Type:Individual
Prefix:
First Name:JOREY
Middle Name:
Last Name:KRAWCZYN
Suffix:
Gender:M
Credentials:IMH2565
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 AIRPORT RD STE A
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4031
Mailing Address - Country:US
Mailing Address - Phone:850-522-4155
Mailing Address - Fax:850-522-4156
Practice Address - Street 1:731 AIRPORT RD STE A
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4031
Practice Address - Country:US
Practice Address - Phone:850-522-4155
Practice Address - Fax:850-522-4156
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH2565101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health