Provider Demographics
NPI:1629052261
Name:CREWS, TANYA L (LPC, NCC, RPT-S)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:L
Last Name:CREWS
Suffix:
Gender:F
Credentials:LPC, NCC, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16622 HIGHLAND SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63011-5423
Mailing Address - Country:US
Mailing Address - Phone:636-728-0510
Mailing Address - Fax:636-728-0511
Practice Address - Street 1:16100 CHESTERFIELD PKWY W
Practice Address - Street 2:SUITE 215
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4871
Practice Address - Country:US
Practice Address - Phone:636-728-0510
Practice Address - Fax:636-728-0511
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO390709OtherWELLCARE
MO818776OtherVALUE OPTIONS
MO001245816OtherCTS
MO1097649OtherCIGNA
MO11563438OtherCAQH
MO0007327169OtherAETNS
MO6280047OtherUNITED HEALTHCARE
MO59360OtherCARPENTERS
MO497854414Medicaid
MO152896OtherBLUE CROSS/BLUE SHIELD
MO390709OtherHARMONY
MO406872OtherHEALTHLINK