Provider Demographics
NPI:1841601150
Name:CRUMB PEREZ, JENNIFER (LCPC, LPHA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CRUMB PEREZ
Suffix:
Gender:F
Credentials:LCPC, LPHA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:CRUMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 RAVINIA PL STE 1C
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3963
Mailing Address - Country:US
Mailing Address - Phone:708-963-0334
Mailing Address - Fax:
Practice Address - Street 1:1500 RAVINIA PL STE 1C
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3963
Practice Address - Country:US
Practice Address - Phone:708-963-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL180.010128101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health