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General NPI Number Information
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NPI Number | 1992560155
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Entity Type | Organization
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Legal Business Name | CRUCIBLE LLC
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 1 W SUNBRIDGE DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1825
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Country | US
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Telephone | 970-903-3441
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Fax |
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Provider Business Mailing Address
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Address Line | 219 W WILLOW ST
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City | ROGERS
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State | AR
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Zip | 72756-5450
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Country | US
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Telephone | 970-903-3441
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MELIA ANN SNYDER
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Credential | PHD, LPC, REAT
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Telephone | 970-903-3441
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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