Provider Demographics
NPI:1801388640
Name:CRUTCHFIELD, JOHNNY JR
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:
Last Name:CRUTCHFIELD
Suffix:JR
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 1:3804 PALMYRA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6009
Mailing Address - Country:US
Mailing Address - Phone:504-255-5899
Mailing Address - Fax:
Practice Address - Street 1:3804 PALMYRA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6009
Practice Address - Country:US
Practice Address - Phone:504-255-5899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health