Provider Demographics
NPI:1629253794
Name:CRUM, DURANT M
Entity Type:Individual
Prefix:
First Name:DURANT
Middle Name:M
Last Name:CRUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 CAPITAL AVE SW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7375
Mailing Address - Country:US
Mailing Address - Phone:269-979-8333
Mailing Address - Fax:269-979-7766
Practice Address - Street 1:3630 CAPITAL AVE SW
Practice Address - Street 2:SUITE 1
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7375
Practice Address - Country:US
Practice Address - Phone:269-979-8333
Practice Address - Fax:269-979-7766
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009878103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist