Provider Demographics
NPI:1588931430
Name:CRISSMAN, DARRELL L (MDIV)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:L
Last Name:CRISSMAN
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 TOLLGATE HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6206
Mailing Address - Country:US
Mailing Address - Phone:724-902-9658
Mailing Address - Fax:
Practice Address - Street 1:189 TOLLGATE HILL RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6206
Practice Address - Country:US
Practice Address - Phone:724-902-9658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor