Healthcare Provider Details

I. General information

NPI: 1922500099
Provider Name (Legal Business Name): ALBERT L. CRUMP, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N ROLLA ST
ROLLA MO
65401-3127
US

IV. Provider business mailing address

PO BOX 53
ROLLA MO
65402-0053
US

V. Phone/Fax

Practice location:
  • Phone: 573-435-2123
  • Fax: 573-240-9790
Mailing address:
  • Phone: 573-435-2123
  • Fax: 573-240-9790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT L CRUMP
Title or Position: OWNER
Credential: LCSW
Phone: 573-514-3951