Healthcare Provider Details

I. General information

NPI: 1427865484
Provider Name (Legal Business Name): TAMARA CROWN, LCSW, ACSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 TALONS REACH RUN
BERTHOUD CO
80513-8701
US

IV. Provider business mailing address

517 TALONS REACH RUN
BERTHOUD CO
80513-8701
US

V. Phone/Fax

Practice location:
  • Phone: 405-630-0189
  • Fax:
Mailing address:
  • Phone: 405-630-0189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MISS TAMARA DAWN CROWN
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 405-630-0189