Provider Demographics
NPI:1811375314
Name:CRIM, BRIAN (LMFT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CRIM
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1701
Mailing Address - Country:US
Mailing Address - Phone:715-410-5822
Mailing Address - Fax:
Practice Address - Street 1:901 DOMINION DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-9326
Practice Address - Country:US
Practice Address - Phone:715-531-6760
Practice Address - Fax:715-531-6761
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1016-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist