Provider Demographics
NPI:1295243186
Name:CRAZY TALK, LLC
Entity type:Organization
Organization Name:CRAZY TALK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SEICKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CAC-AD
Authorized Official - Phone:240-385-7599
Mailing Address - Street 1:168 HARPERS WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3064
Mailing Address - Country:US
Mailing Address - Phone:410-960-3811
Mailing Address - Fax:
Practice Address - Street 1:65 THOMAS JOHNSON DR STE A
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4371
Practice Address - Country:US
Practice Address - Phone:240-385-7599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-14
Last Update Date:2018-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2324261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)