Provider Demographics
NPI:1194873414
Name:MELLOR-CRUMMEY, CYNTHIA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANN
Last Name:MELLOR-CRUMMEY
Suffix:
Gender:F
Credentials:PHD
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 310387
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77231-0387
Mailing Address - Country:US
Mailing Address - Phone:713-813-6740
Mailing Address - Fax:713-721-7174
Practice Address - Street 1:101 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3668
Practice Address - Country:US
Practice Address - Phone:713-813-6740
Practice Address - Fax:713-721-7174
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24287103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX022594OtherVALUEOPTIONS PROVIDER #
TX0027CMOtherBLUE CROSS & BLUE SHIELD