MEDICARE: TAYLOR CRUM LSW, LICDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	S.2512302	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.162845	OH

General Provider Information

NPI Number	:	1952812133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR CRUM LSW, LICDC

Provider Business Mailing Address
First Line	:	1848 E PERRY ST STE 900
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-1443
Country	:	US
Telephone Number	:	937-210-9736
Fax Number	:

Provider Business Practice Location Address
First Line	:	1848 E PERRY ST STE 900
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-1443
Country	:	US
Telephone Number	:	937-210-9736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2017
Last Update Date	:	01/31/2026

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