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NPI Code Detail

MEDICARE: JOSHUA CRUM

MEDICARE:   JOSHUA  CRUM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1457967242
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSHUA CRUM
Provider Business Mailing Address
First Line : 103 VILLA DR
Second Line :
City : SAN PABLO
State : CA
Zip : 94806-3768
Country : US
Telephone Number : 510-717-4564
Fax Number :
Provider Business Practice Location Address
First Line : 103 VILLA DR
Second Line :
City : SAN PABLO
State : CA
Zip : 94806-3768
Country : US
Telephone Number : 510-717-4564
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2020
Last Update Date : 01/23/2024

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Directions to “ JOSHUA CRUM ” Practice Location

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