1629052261 NPI number — TANYA L CREWS LPC, NCC, RPT-S

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629052261 NPI number — TANYA L CREWS LPC, NCC, RPT-S

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CREWS

Provider First Name:

TANYA

Provider Middle Name:

L

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

LPC, NCC, RPT-S

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1629052261

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/24/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

16622 HIGHLAND SUMMIT DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WILDWOOD

Provider Business Mailing Address State Name:

MO

Provider Business Mailing Address Postal Code:

63011-5423

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

636-728-0510

Provider Business Mailing Address Fax Number:

636-728-0511

Provider First Line Business Practice Location Address:

16100 CHESTERFIELD PKWY W

Provider Second Line Business Practice Location Address:

SUITE 215

Provider Business Practice Location Address City Name:

CHESTERFIELD

Provider Business Practice Location Address State Name:

MO

Provider Business Practice Location Address Postal Code:

63017-4871

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

636-728-0510

Provider Business Practice Location Address Fax Number:

636-728-0511

Provider Enumeration Date:

12/06/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

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

• Identifier: 390709 . This is a "WELLCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 818776 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 001245816 . This is a "CTS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 1097649 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 11563438 . This is a "CAQH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 0007327169 . This is a "AETNS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 6280047 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 59360 . This is a "CARPENTERS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 497854414 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
• Identifier: 152896 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 390709 . This is a "HARMONY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 406872 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".