Provider Demographics
NPI:1013495134
Name:THERESA CRUMPTON COUNSELING SERVICE, LLC
Entity Type:Organization
Organization Name:THERESA CRUMPTON COUNSELING SERVICE, LLC
Other - Org Name:THERESA CRUMPTON COUNSELING SERVICES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:971-803-3933
Mailing Address - Street 1:29781 SW TOWN CENTER LOOP W STE 200
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-8902
Mailing Address - Country:US
Mailing Address - Phone:971-803-3933
Mailing Address - Fax:
Practice Address - Street 1:29781 SW TOWN CENTER LOOP W STE 200
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8902
Practice Address - Country:US
Practice Address - Phone:971-803-3933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty