Provider Demographics
NPI:1104330075
Name:KRUMREY, ALICIA SHAWN (LCDC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:SHAWN
Last Name:KRUMREY
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5711 LAVENDER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77026-1725
Mailing Address - Country:US
Mailing Address - Phone:979-676-3144
Mailing Address - Fax:
Practice Address - Street 1:5711 LAVENDER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-1725
Practice Address - Country:US
Practice Address - Phone:979-676-3144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10429101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXUNKNOWNOtherPRIVATE INSURANCE