Provider Demographics
NPI:1114384740
Name:CRABTREE, EMMA AILEEN JUDD (LPC-MHSP)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:AILEEN JUDD
Last Name:CRABTREE
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:MS
Other - First Name:EMMA
Other - Middle Name:AILEEN
Other - Last Name:JUDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-MHSP
Mailing Address - Street 1:570 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1876
Mailing Address - Country:US
Mailing Address - Phone:931-372-7117
Mailing Address - Fax:931-372-7119
Practice Address - Street 1:570 E 10TH ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1876
Practice Address - Country:US
Practice Address - Phone:931-372-7117
Practice Address - Fax:931-372-7119
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3936101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ029028Medicaid