Provider Demographics
NPI:1508302829
Name:CATHERINE CRANDALL COUNSELING, LLC
Entity Type:Organization
Organization Name:CATHERINE CRANDALL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TIN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-727-5218
Mailing Address - Street 1:920 S MANOR RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5068
Mailing Address - Country:US
Mailing Address - Phone:812-727-5218
Mailing Address - Fax:
Practice Address - Street 1:4658 E. STATE RD. 45
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-9644
Practice Address - Country:US
Practice Address - Phone:812-797-5218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty