=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801074356
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LANCE JOHN CROWLEY MA, LADC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2008
-----------------------------------------------------
Last Update Date | 02/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1528 US HIGHWAY 395 S SUITE 250
-----------------------------------------------------
City | GARDNERVILLE
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89410-5265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-721-8463
-----------------------------------------------------
Fax | 775-783-8080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1528 US HIGHWAY 395 S SUITE 250
-----------------------------------------------------
City | GARDNERVILLE
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89410-5265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-721-8463
-----------------------------------------------------
Fax | 775-783-8080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 773
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------