Healthcare Provider Details

I. General information

NPI: 1528309069
Provider Name (Legal Business Name): JASON COLTE CROW PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 E SHIELDS AVE
FRESNO CA
93726-7029
US

IV. Provider business mailing address

2947 N FILBERT AVE
FRESNO CA
93727-1420
US

V. Phone/Fax

Practice location:
  • Phone: 209-725-1060
  • Fax:
Mailing address:
  • Phone: 559-286-6769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: