Provider Demographics
NPI:1689111924
Name:CRUMLEY, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CRUMLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 S CICERO AVE STE F
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4098
Mailing Address - Country:US
Mailing Address - Phone:708-232-8763
Mailing Address - Fax:708-232-8993
Practice Address - Street 1:10201 S CICERO AVE STE F
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4098
Practice Address - Country:US
Practice Address - Phone:708-232-8763
Practice Address - Fax:708-232-8993
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008624101YM0800X
IL180012653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health