Provider Demographics
NPI:1083155402
Name:CRUMP, AMBROSIA LEE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMBROSIA
Middle Name:LEE
Last Name:CRUMP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60066
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89160-0066
Mailing Address - Country:US
Mailing Address - Phone:702-567-9247
Mailing Address - Fax:877-917-9818
Practice Address - Street 1:3690 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3300
Practice Address - Country:US
Practice Address - Phone:702-756-9247
Practice Address - Fax:877-917-9818
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8797-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical