Healthcare Provider Details

I. General information

NPI: 1437689304
Provider Name (Legal Business Name): THOMAS W CRISSMAN M.A., LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 WOOD ST
CLARION PA
16214-1240
US

IV. Provider business mailing address

46 S 7TH AVE
CLARION PA
16214-1514
US

V. Phone/Fax

Practice location:
  • Phone: 724-787-3365
  • Fax: 724-787-3365
Mailing address:
  • Phone: 724-787-3365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC009519
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: