Healthcare Provider Details

I. General information

NPI: 1194911313
Provider Name (Legal Business Name): CRUTCHFIELD COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 MAIN ST
DUNEDIN FL
34698-4759
US

IV. Provider business mailing address

PO BOX 605
SAFETY HARBOR FL
34695-0605
US

V. Phone/Fax

Practice location:
  • Phone: 727-736-3132
  • Fax: 727-736-3052
Mailing address:
  • Phone: 727-736-3132
  • Fax: 727-736-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5217
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW4752
License Number StateFL

VIII. Authorized Official

Name: DR. GLORIA P CRUTCHFIELD
Title or Position: PRESIDENT/PSYCHOLOGIST
Credential: PHD
Phone: 727-736-3132