Healthcare Provider Details

I. General information

NPI: 1023964111
Provider Name (Legal Business Name): TRACY L CRUTCHFIELD ED.D., PSY.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8805 135TH LOOP
LIVE OAK FL
32060-6382
US

IV. Provider business mailing address

8805 135TH LOOP
LIVE OAK FL
32060-6382
US

V. Phone/Fax

Practice location:
  • Phone: 386-590-0086
  • Fax:
Mailing address:
  • Phone: 386-590-0086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1003
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: