Provider Demographics
NPI:1235322801
Name:CRUTCHFIELD, MARNEE (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:MARNEE
Middle Name:
Last Name:CRUTCHFIELD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12650 N. BEACH STREET
Mailing Address - Street 2:SUITE 114, #204
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244
Mailing Address - Country:US
Mailing Address - Phone:832-338-4711
Mailing Address - Fax:
Practice Address - Street 1:4425 W AIRPORT FWY STE 122
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5817
Practice Address - Country:US
Practice Address - Phone:832-338-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1235322801Medicaid