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NPI Code Detail

MEDICARE: MR. RODRICK JAMES CRUTCHFIELD I

MEDICARE: MR. RODRICK JAMES CRUTCHFIELD I
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
1101YM0800XMental Health Counselor171M00000XAR

General Provider Information

NPI Number : 1649684804
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RODRICK JAMES CRUTCHFIELD I
Provider Business Mailing Address
First Line : 632 W BROADWAY ST
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72114-5526
Country : US
Telephone Number : 501-955-2674
Fax Number :
Provider Business Practice Location Address
First Line : 632 W BROADWAY ST
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72114-5526
Country : US
Telephone Number : 501-955-2674
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2014
Last Update Date : 06/16/2014

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Directions to “ MR. RODRICK JAMES CRUTCHFIELD I ” Practice Location

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