MEDICARE: DR. TIMOTHY CROUCH PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1457	CO

General Provider Information

NPI Number	:	1689774762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY CROUCH PHD

Provider Business Mailing Address
First Line	:	8670 WOLFF CT STE 130
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80031-3692
Country	:	US
Telephone Number	:	720-272-9272
Fax Number	:	303-430-5306

Provider Business Practice Location Address
First Line	:	8670 WOLFF CT STE 130
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80031-3692
Country	:	US
Telephone Number	:	720-272-9272
Fax Number	:	303-430-5306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	08/14/2013

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