=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659882660
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KRUMROY AND ASSOCIATES THERAPEUTIC COUNSELING SERVICES, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2017
-----------------------------------------------------
Last Update Date | 10/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 430 BATTLEGROUND AVE
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-2104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-543-0172
-----------------------------------------------------
Fax | 844-642-5118
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 430 BATTLEGROUND AVE
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-2104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-543-0172
-----------------------------------------------------
Fax | 844-642-5118
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TAYLOR ROSS KRUMROY
-----------------------------------------------------
Credential | MSW, LCSW
-----------------------------------------------------
Telephone | 336-543-0172
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C008487
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------