MEDICARE: DR. ROY HOWARD CROUSE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810002327	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225095458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY HOWARD CROUSE PHD

Provider Business Mailing Address
First Line	:	820 UNIVERSITY CITY BLVD
Second Line	:	SUITE 1
City	:	BLACKSBURG
State	:	VA
Zip	:	24060-2708
Country	:	US
Telephone Number	:	540-961-2380
Fax Number	:	540-961-3408

Provider Business Practice Location Address
First Line	:	820 UNIVERSITY CITY BLVD
Second Line	:	SUITE 1
City	:	BLACKSBURG
State	:	VA
Zip	:	24060-2708
Country	:	US
Telephone Number	:	540-961-2380
Fax Number	:	540-961-3408

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	01/23/2013

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