MEDICARE: MRS. JANIS CRUMB

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1861881369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANIS CRUMB

Provider Business Mailing Address
First Line	:	1818 GILBRETH RD STE 230
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-1217
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 GILBRETH RD STE 230
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-1217
Country	:	US
Telephone Number	:	650-348-6603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2015
Last Update Date	:	01/21/2015

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