Provider Demographics
NPI:1346280617
Name:CRUM, JARRETT (LCSW)
Entity Type:Individual
Prefix:
First Name:JARRETT
Middle Name:
Last Name:CRUM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761B MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1715
Mailing Address - Country:US
Mailing Address - Phone:251-928-4750
Mailing Address - Fax:251-990-2560
Practice Address - Street 1:761B MIDDLE ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1715
Practice Address - Country:US
Practice Address - Phone:251-928-4750
Practice Address - Fax:251-990-2560
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1321C101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS62071Medicare UPIN
AL51501073Medicare ID - Type Unspecified