Provider Demographics
NPI:1467812487
Name:CRUMP, MARLO M (LPC-IT)
Entity Type:Individual
Prefix:
First Name:MARLO
Middle Name:M
Last Name:CRUMP
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:MARLO
Other - Middle Name:M
Other - Last Name:GREENLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-3919
Mailing Address - Country:US
Mailing Address - Phone:608-755-8923
Mailing Address - Fax:608-758-5761
Practice Address - Street 1:20 E COURT ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-3919
Practice Address - Country:US
Practice Address - Phone:608-755-8923
Practice Address - Fax:608-758-5761
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2661-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional