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General NPI Number Information
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NPI Number | 1194911313
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Entity Type | Organization
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Legal Business Name | CRUTCHFIELD COUNSELING INC
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1613 MAIN ST
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City | DUNEDIN
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State | FL
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Zip | 34698-4759
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Country | US
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Telephone | 727-736-3132
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Fax | 727-736-3052
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Provider Business Mailing Address
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Address Line | PO BOX 605
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City | SAFETY HARBOR
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State | FL
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Zip | 34695-0605
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Country | US
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Telephone | 727-736-3132
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Fax | 727-736-3052
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Authorized Official
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Title or Position | PRESIDENT/PSYCHOLOGIST
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Name | DR. GLORIA P CRUTCHFIELD
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Credential | PHD
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Telephone | 727-736-3132
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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 | SW4752
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY5217
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License Number State | FL
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