Healthcare Provider Details

I. General information

NPI: 1609079102
Provider Name (Legal Business Name): CYNTHIA JEAN CROWSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 HIGHWAY 270 EAST
MT. IDA AR
71957
US

IV. Provider business mailing address

PO BOX 1394
MOUNT IDA AR
71957-1394
US

V. Phone/Fax

Practice location:
  • Phone: 870-557-4888
  • Fax:
Mailing address:
  • Phone: 870-557-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2472-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: