Provider Demographics
NPI:1225392194
Name:CRUM, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CRUM
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 1:764 ROYAL WOODS DR W
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-9220
Mailing Address - Country:US
Mailing Address - Phone:251-367-5621
Mailing Address - Fax:251-633-5865
Practice Address - Street 1:764 ROYAL WOODS DR W
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-9220
Practice Address - Country:US
Practice Address - Phone:251-367-5621
Practice Address - Fax:251-633-5865
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL812195171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator