Provider Demographics
NPI:1538608161
Name:CRUMP, AGATA (MED, MA)
Entity type:Individual
Prefix:
First Name:AGATA
Middle Name:
Last Name:CRUMP
Suffix:
Gender:F
Credentials:MED, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 EXECUTIVE CENTER DR
Mailing Address - Street 2:STE. 212
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1680
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5808 BALCONES DR
Practice Address - Street 2:SUITE #201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4255
Practice Address - Country:US
Practice Address - Phone:512-537-4560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76923101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health