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NPI Code Detail

MEDICARE: JOHN BRYAN CRUSIUS LPC

MEDICARE: JOHN BRYAN CRUSIUS LPC
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 Counselor62107TX

General Provider Information

NPI Number : 1952970774
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN BRYAN CRUSIUS LPC
Provider Business Mailing Address
First Line : PO BOX 831544
Second Line :
City : RICHARDSON
State : TX
Zip : 75083-1544
Country : US
Telephone Number : 214-893-7922
Fax Number :
Provider Business Practice Location Address
First Line : 1001 HAMPSHIRE LN STE 400
Second Line :
City : RICHARDSON
State : TX
Zip : 75080-5143
Country : US
Telephone Number : 214-893-7922
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2021
Last Update Date : 06/24/2021

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