Provider Demographics
NPI:1245431022
Name:CRUM, JOHN PALMER (LCPC, LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PALMER
Last Name:CRUM
Suffix:
Gender:M
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 N RESEARCH DR STE 110
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3604
Mailing Address - Country:US
Mailing Address - Phone:618-692-6880
Mailing Address - Fax:314-667-3108
Practice Address - Street 1:95 N RESEARCH DR STE 110
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3604
Practice Address - Country:US
Practice Address - Phone:618-692-6880
Practice Address - Fax:314-667-3108
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004715101YA0400X, 101YM0800X
MO2007012895101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL262844611OtherSTATE
IL262844611OtherIL