Provider Demographics
NPI:1942603436
Name:CRUSEY, SCOTT HANSEN
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:HANSEN
Last Name:CRUSEY
Suffix:
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 1:5384 MARY FELLOWS AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1340
Mailing Address - Country:US
Mailing Address - Phone:619-895-3555
Mailing Address - Fax:
Practice Address - Street 1:5384 MARY FELLOWS AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1340
Practice Address - Country:US
Practice Address - Phone:619-895-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CALMFT134783106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor