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General NPI Number Information
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NPI Number | 1871650911
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Entity Type | Individual
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Provider Name | AMY BETH KRUCHKOFF LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 18001 N 79TH AVE STE C53
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City | GLENDALE
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State | AZ
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Zip | 85308-8388
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Country | US
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Telephone | 623-979-2525
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Fax | 623-979-2529
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Provider Business Mailing Address
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Address Line | 2471 W WINCHCOMB DR
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City | PHOENIX
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State | AZ
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Zip | 85023-5929
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Country | US
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Telephone | 602-789-1477
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT0300
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License Number State | AZ
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