Provider Demographics
NPI:1750756532
Name:CRUMP, VERNEKIE
Entity type:Individual
Prefix:
First Name:VERNEKIE
Middle Name:
Last Name:CRUMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7119 BRISTOL MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4289
Mailing Address - Country:US
Mailing Address - Phone:901-491-6653
Mailing Address - Fax:
Practice Address - Street 1:7119 BRISTOL MEADOW LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4289
Practice Address - Country:US
Practice Address - Phone:901-491-6653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-05
Last Update Date:2015-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNBA0000132103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN208D00000XOtherOTHER NON SPECIFIED