Healthcare Provider Details

I. General information

NPI: 1689774762
Provider Name (Legal Business Name): TIMOTHY CROUCH PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8670 WOLFF CT STE 130
WESTMINSTER CO
80031-3692
US

IV. Provider business mailing address

8670 WOLFF CT STE 130
WESTMINSTER CO
80031-3692
US

V. Phone/Fax

Practice location:
  • Phone: 720-272-9272
  • Fax: 303-430-5306
Mailing address:
  • Phone: 720-272-9272
  • Fax: 303-430-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1457
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: