Provider Demographics
NPI:1447867361
Name:CRUTCHFIELD PSYCHOLOGY INC
Entity type:Organization
Organization Name:CRUTCHFIELD PSYCHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:CRUTCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-656-5753
Mailing Address - Street 1:PO BOX 1465
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-1465
Mailing Address - Country:US
Mailing Address - Phone:727-458-3014
Mailing Address - Fax:727-472-0338
Practice Address - Street 1:1613 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-4759
Practice Address - Country:US
Practice Address - Phone:727-736-3132
Practice Address - Fax:727-472-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty