Individual
JOHN PALMER CRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC, LPC
Contact information
Practice address
95 N RESEARCH DR STE 110, EDWARDSVILLE, IL 62025-3604
(618) 692-6880
(314) 667-3108
Mailing address
95 N RESEARCH DR STE 110, EDWARDSVILLE, IL 62025-3604
(618) 692-6880
(314) 667-3108
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
180004715
IL
101YA0400X
Addiction (Substance Use Disorder) Counselor
2007012895
MO
101YM0800X
Mental Health Counselor
180004715
IL
101YM0800X
Mental Health Counselor
2007012895
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
262844611
STATE
IL
Enumeration date
05/30/2007
Last updated
09/10/2013
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