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General NPI Number Information
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NPI Number | 1467874990
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Entity Type | Organization
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Legal Business Name | MICKEY CROTHERS, PH.D., LLC
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Dates
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Enumeration Date | 01/17/2014
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Last Update Date | 02/18/2014
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Provider Practice Location Address
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Address Line | 4330 GOLF TER SUITE 213-M
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City | EAU CLAIRE
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State | WI
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Zip | 54701-4683
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Country | US
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Telephone | 715-830-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 4330 GOLF TER SUITE 213-M
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City | EAU CLAIRE
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State | WI
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Zip | 54701-4683
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Country | US
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Telephone | 715-830-1400
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. MARIE K. (MICKEY) CROTHERS
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Credential | PH.D.
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Telephone | 715-830-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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