Provider Demographics
NPI:1184767790
Name:CRUMPTON, KEN SHARROD (MA, MFT)
Entity type:Individual
Prefix:MR
First Name:KEN
Middle Name:SHARROD
Last Name:CRUMPTON
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ASHTONBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-6704
Mailing Address - Country:US
Mailing Address - Phone:770-377-7553
Mailing Address - Fax:
Practice Address - Street 1:595 OLD NORCROSS RD
Practice Address - Street 2:BLDG. B
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3327
Practice Address - Country:US
Practice Address - Phone:770-995-6901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist