Provider Demographics
NPI:1841385721
Name:CRUME, MARY JEAN (MSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JEAN
Last Name:CRUME
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:CRUME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:210 S PULASKI ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-1926
Mailing Address - Country:US
Mailing Address - Phone:501-666-9220
Mailing Address - Fax:501-374-3852
Practice Address - Street 1:210 S PULASKI ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-1926
Practice Address - Country:US
Practice Address - Phone:501-666-9220
Practice Address - Fax:501-374-3852
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR964-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical