Provider Demographics
NPI:1083840557
Name:CRUMBAUGH, PAMELA R (MSED, LPC-MHSP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:CRUMBAUGH
Suffix:
Gender:F
Credentials:MSED, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10142 PARKSIDE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-1955
Mailing Address - Country:US
Mailing Address - Phone:765-977-4415
Mailing Address - Fax:615-369-8697
Practice Address - Street 1:10142 PARKSIDE DR STE 114
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-1955
Practice Address - Country:US
Practice Address - Phone:765-977-4415
Practice Address - Fax:615-369-8697
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0700466101YM0800X
TN7919101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health