Healthcare Provider Details

I. General information

NPI: 1609815430
Provider Name (Legal Business Name): MARK A CROW LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 HOLLY LN
SALINA KS
67401
US

IV. Provider business mailing address

730 HOLLY LN
SALINA KS
67401
US

V. Phone/Fax

Practice location:
  • Phone: 785-452-4930
  • Fax: 785-452-4932
Mailing address:
  • Phone: 785-452-4930
  • Fax: 785-452-4932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number064
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: