Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003396540 |
---|---|
Provider Name | Korey Crum |
First Address | Cape Girardeau, MO 63703-6212 |
Second Address | Cape Girardeau, MO 63703-6212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2018 |
Last Update Date | 21/01/2022 |