Provider Demographics
NPI:1548456445
Name:CRUMBLY, MICHELLE R
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:CRUMBLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 STAGE RD
Mailing Address - Street 2:SUITE M
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5109
Mailing Address - Country:US
Mailing Address - Phone:334-887-2001
Mailing Address - Fax:334-887-2009
Practice Address - Street 1:923 STAGE RD
Practice Address - Street 2:SUITE M
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-5109
Practice Address - Country:US
Practice Address - Phone:334-887-2001
Practice Address - Fax:334-887-2009
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSLPC 1171101YP2500X
AL2814101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional