MEDICARE: TANISIA J CROWDER LCSW

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	1041C0700X	Clinical Social Worker	34008229A	IN

General Provider Information

NPI Number	:	1225510183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANISIA J CROWDER LCSW

Provider Business Mailing Address
First Line	:	1389 W 86TH ST # 124
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2101
Country	:	US
Telephone Number	:	317-941-6106
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 W 86TH ST STE 240
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1965
Country	:	US
Telephone Number	:	317-941-6106
Fax Number	:

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

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	02/11/2020

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