Basic Information
| Provider Information | |||||||||
| NPI: | 1609856137 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUTHIRDS | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11601 OLD BILOXI RD | ||||||||
| Address2: | |||||||||
| City: | OCEAN SPRINGS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395657743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2283925099 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 FISHER ST | ||||||||
| Address2: | 81 MDOS SGOW | ||||||||
| City: | KEESLER AFB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2283763469 | ||||||||
| FaxNumber: | 2283778468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 09/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C6337 | MS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.