Healthcare Provider Details

I. General information

NPI: 1487583720
Provider Name (Legal Business Name): GHAVINN GERREMY CRUTCHER LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 W CAMDEN DR
ELK GROVE CA
95624-3036
US

IV. Provider business mailing address

8701 W CAMDEN DR
ELK GROVE CA
95624-3036
US

V. Phone/Fax

Practice location:
  • Phone: 916-607-1261
  • Fax:
Mailing address:
  • Phone: 916-607-1261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number107974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: