Provider Demographics
NPI:1982708434
Name:CRAINE, BRENDA KAY (BSW)
Entity Type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:KAY
Last Name:CRAINE
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 HWY 3095
Mailing Address - Street 2:
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611
Mailing Address - Country:US
Mailing Address - Phone:662-564-4116
Mailing Address - Fax:
Practice Address - Street 1:214 INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MS
Practice Address - Zip Code:38603-6761
Practice Address - Country:US
Practice Address - Phone:662-224-0078
Practice Address - Fax:662-224-0079
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health