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General NPI Number Information
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NPI Number | 1194614636
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Entity Type | Individual
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Provider Name | ALAN CROUCH PR
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Gender | Male
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 137 8TH AVE W
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City | HUNTINGTON
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State | WV
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Zip | 25701-2510
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Country | US
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Telephone | 304-408-3256
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Fax | 304-756-8230
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Provider Business Mailing Address
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Address Line | 2207 23RD ST
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City | PARKERSBURG
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State | WV
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Zip | 26101-3701
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Country | US
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Telephone | 304-408-3256
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Fax | 304-756-8230
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 22-9134
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License Number State | WV
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