Healthcare Provider Details

I. General information

NPI: 1437704590
Provider Name (Legal Business Name): AUTUMN CRUMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 MAHONING AVE NW
WARREN OH
44483-4605
US

IV. Provider business mailing address

435 ARBOR CIR
YOUNGSTOWN OH
44505-1979
US

V. Phone/Fax

Practice location:
  • Phone: 330-394-6244
  • Fax:
Mailing address:
  • Phone: 330-599-9028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: