Provider Demographics
NPI:1477565596
Name:CRUTCHFIELD, FREIDA A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:FREIDA
Middle Name:A
Last Name:CRUTCHFIELD
Suffix:
Gender:F
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:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:26 MIDWAY
Practice Address - Street 2:BRISTOL REGIONAL COUNSELING CTR
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-989-4500
Practice Address - Fax:423-989-4582
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLCSW3515104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
BRCC243511GVB24333OtherANTHEM PROF TRIGON
81487OtherUBH HEALTHPLAN
3065775OtherMAGELLAN SUMMIT
81487OtherUBH JOHN DEERE
3065775OtherMAGELLAN PINNACLE
BRCC243511FVB24333OtherANTHEM PREF TRIGON
334969OtherVALUEOPTIONS GROUP
3065775OtherMAGELLAN NAVIGATOR
1047057OtherCIGNA MCC
81487OtherUBH EMPLOYER
81487OtherUBH SENIOR
BRCC243511GVB24333OtherANTHEM PROF TRIGON
81487OtherUBH SENIOR