Provider Demographics
NPI:1154613917
Name:CRUTCHFIELD, MICHAEL (BA BHRS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CRUTCHFIELD
Suffix:
Gender:M
Credentials:BA BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 SOUTH B STREET
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:OK
Mailing Address - Zip Code:74730
Mailing Address - Country:US
Mailing Address - Phone:580-212-4458
Mailing Address - Fax:
Practice Address - Street 1:105 PLAZA
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446
Practice Address - Country:US
Practice Address - Phone:580-795-7443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health