Provider Demographics
NPI:1356312276
Name:CRUMMETT, ALLAN WARREN (EDD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:WARREN
Last Name:CRUMMETT
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 OAK AVE.
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442
Mailing Address - Country:US
Mailing Address - Phone:231-773-8093
Mailing Address - Fax:231-773-8952
Practice Address - Street 1:1804 OAK AVE.
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442
Practice Address - Country:US
Practice Address - Phone:231-773-8093
Practice Address - Fax:231-773-8952
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006533103TC1900X
103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM029687OtherTRICARE
MI680F14520OtherBLUECROSS OF MICHIGAN
MI680F14520OtherBLUECROSS OF MICHIGAN