1336638386 NPI number — AMBERA D CROSBY MS,LPC

Table of content: AMBERA D CROSBY MS,LPC (NPI 1336638386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336638386 NPI number — AMBERA D CROSBY MS,LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROSBY
Provider First Name:
AMBERA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS,LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROSBY
Provider Other First Name:
AMBER
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336638386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4347 BENNINGTON CREEK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROVEPORT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43125-8900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-805-2129
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6321 E LIVINGSTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REYNOLDSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43068-4241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-870-6670
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)