Provider Demographics
NPI:1912467416
Name:CRISP, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CRISP
Suffix:
Gender:F
Credentials:
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 931142
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-1142
Mailing Address - Country:US
Mailing Address - Phone:615-247-5487
Mailing Address - Fax:
Practice Address - Street 1:619 N 30TH ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4047
Practice Address - Country:US
Practice Address - Phone:270-444-7898
Practice Address - Fax:270-933-1786
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRBT-19-77799106S00000X
KY0-24-15285106E00000X
KY1-24-76666103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst