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General NPI Number Information
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NPI Number | 1184040941
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Entity Type | Organization
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Legal Business Name | CRYSTAL NUSS, LCSW, PIP
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 230 N WALSTON BRIDGE RD
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City | JASPER
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State | AL
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Zip | 35504-8623
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Country | US
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Telephone | 205-300-4857
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Fax |
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Provider Business Mailing Address
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Address Line | 230 N WALSTON BRIDGE RD
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City | JASPER
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State | AL
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Zip | 35504-8623
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Country | US
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Telephone | 205-300-4857
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | MRS. CRYSTAL NUSS
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Credential | LCSW, PIP
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Telephone | 205-300-4857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3529C
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License Number State | AL
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