Provider Demographics
NPI:1235332750
Name:CRUMLEY, GREG S (LCMFT)
Entity type:Individual
Prefix:MR
First Name:GREG
Middle Name:S
Last Name:CRUMLEY
Suffix:
Gender:M
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17219 W 39TH ST S
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-8256
Mailing Address - Country:US
Mailing Address - Phone:316-214-5247
Mailing Address - Fax:888-416-7189
Practice Address - Street 1:313 N SENECA ST STE 108
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5937
Practice Address - Country:US
Practice Address - Phone:316-214-5247
Practice Address - Fax:888-416-7189
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8111041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201070970AMedicaid