Provider Demographics
NPI:1831312271
Name:CRIM, DARRELL LEE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:LEE
Last Name:CRIM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 PENNSYLVANIA AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2259
Mailing Address - Country:US
Mailing Address - Phone:817-731-7107
Mailing Address - Fax:817-731-7422
Practice Address - Street 1:1015 PENNSYLVANIA AVE STE 3
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2259
Practice Address - Country:US
Practice Address - Phone:817-731-7107
Practice Address - Fax:817-731-7422
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX286231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical