Provider Demographics
NPI:1487944393
Name:CRUMBLEY, EARNEST JR (BA SOCIOLOGY)
Entity type:Individual
Prefix:MR
First Name:EARNEST
Middle Name:
Last Name:CRUMBLEY
Suffix:JR
Gender:M
Credentials:BA SOCIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11501 LOCHWOOD DR
Mailing Address - Street 2:APT 804
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6604
Mailing Address - Country:US
Mailing Address - Phone:727-709-2563
Mailing Address - Fax:
Practice Address - Street 1:11501 LOCHWOOD DR
Practice Address - Street 2:APT 804
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6604
Practice Address - Country:US
Practice Address - Phone:727-709-2563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health