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Individual

TATANISHA CRUMBLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
623 SLATE DR APT B, INDIANAPOLIS, IN 46227-5086
(317) 238-0294
Mailing address
623 SLATE DR APT B, INDIANAPOLIS, IN 46227-5086
(317) 238-0294

Taxonomy

Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00000000
IN
Enumeration date
03/31/2022
Last updated
03/31/2022
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