Healthcare Provider Details

I. General information

NPI: 1710803929
Provider Name (Legal Business Name): NICHOLAS TYLER CROWL LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 48TH ST
DES MOINES IA
50310-1988
US

IV. Provider business mailing address

5406 MERLE HAY RD
JOHNSTON IA
50131-1209
US

V. Phone/Fax

Practice location:
  • Phone: 515-727-8750
  • Fax: 515-727-8757
Mailing address:
  • Phone: 515-727-8750
  • Fax: 515-727-8757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number101591
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: