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General NPI Number Information
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NPI Number | 1457003451
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Entity Type | Individual
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Provider Name | EBONY CRISP LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/20/2022
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 3127 33RD AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55406-2022
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Country | US
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Telephone | 312-647-9314
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Fax |
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Provider Business Mailing Address
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Address Line | 3127 33RD AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55406-2022
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Country | US
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Telephone | 312-647-9314
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 33018
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 149.024156
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License Number State | IL
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