Provider Demographics
NPI:1598234924
Name:CRUM, JOHN PAUL (PSYD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:CRUM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 PLUMAS ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1730
Mailing Address - Country:US
Mailing Address - Phone:775-657-9597
Mailing Address - Fax:775-322-2964
Practice Address - Street 1:645 PLUMAS ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1730
Practice Address - Country:US
Practice Address - Phone:775-657-9597
Practice Address - Fax:775-562-7570
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0880103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1598234924Medicaid
NV1578113601Medicaid