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NPI Code Detail

MEDICARE: DIANE CRUTCHFIELD

MEDICARE: DIANE 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
1101Y00000XCounselor

General Provider Information

NPI Number : 1891109104
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE CRUTCHFIELD
Provider Business Mailing Address
First Line : 2713 ORCHID VALLEY DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89134-7327
Country : US
Telephone Number : 702-689-5744
Fax Number :
Provider Business Practice Location Address
First Line : 5138 N JULIANO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-4110
Country : US
Telephone Number : 702-940-7896
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2014
Last Update Date : 06/13/2014

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Directions to “ DIANE CRUTCHFIELD ” Practice Location

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