Provider Demographics
NPI:1962563668
Name:CROOKSHANKS, PHILLIP R
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:R
Last Name:CROOKSHANKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SENECA HEALTH SERVICES INC
Mailing Address - Street 2:1305 WEBSTER ROAD
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651
Mailing Address - Country:US
Mailing Address - Phone:304-872-6577
Mailing Address - Fax:304-872-5415
Practice Address - Street 1:SENECA HEALTH SERVICES INC
Practice Address - Street 2:100 CHURCH STREET
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901
Practice Address - Country:US
Practice Address - Phone:304-645-3319
Practice Address - Fax:304-645-6532
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling