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NPI Code Detail

MEDICARE: AUDREY CELENA CRUTCHFIELD

MEDICARE:   AUDREY CELENA CRUTCHFIELD
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
1104100000XSocial Worker150114473IL

General Provider Information

NPI Number : 1578495206
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY CELENA CRUTCHFIELD
Provider Business Mailing Address
First Line : 125 BUCK TRAIL LN
Second Line :
City : ATOKA
State : TN
Zip : 38004-2502
Country : US
Telephone Number : 901-552-6318
Fax Number : 901-552-6318
Provider Business Practice Location Address
First Line : 116 N PAULINE ST
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-1005
Country : US
Telephone Number : 901-552-6318
Fax Number : 901-552-6318
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2026
Last Update Date : 05/29/2026

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Directions to “ AUDREY CELENA CRUTCHFIELD ” Practice Location

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