Healthcare Provider Details

I. General information

NPI: 1609856137
Provider Name (Legal Business Name): CYNTHIA C CRUTHIRDS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FISHER ST 81 MDOS SGOW
KEESLER AFB MS
39531
US

IV. Provider business mailing address

11601 OLD BILOXI RD
OCEAN SPRINGS MS
39565-7743
US

V. Phone/Fax

Practice location:
  • Phone: 228-376-3469
  • Fax: 228-377-8468
Mailing address:
  • Phone: 228-392-5099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC6337
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: