Provider Demographics
NPI:1710251657
Name:CRUM, ELISA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:
Last Name:CRUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 KING BLVD STE 313
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3169
Mailing Address - Country:US
Mailing Address - Phone:307-462-4876
Mailing Address - Fax:
Practice Address - Street 1:2435 KING BLVD STE 313
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3169
Practice Address - Country:US
Practice Address - Phone:307-462-4876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-4941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical