Healthcare Provider Details

I. General information

NPI: 1306670757
Provider Name (Legal Business Name): PAUL CROUCH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 S MAIN
PADEN OK
74860
US

IV. Provider business mailing address

361151 E 1000 RD
PADEN OK
74860-7182
US

V. Phone/Fax

Practice location:
  • Phone: 405-567-9929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12330
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: