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NPI Code Detail

MEDICARE: MR. CARL KOONCE CROWTHER MS, LPC

MEDICARE: MR. CARL KOONCE CROWTHER MS, LPC
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
1101Y00000XCounselor11343TX

General Provider Information

NPI Number : 1275569626
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CARL KOONCE CROWTHER MS, LPC
Provider Business Mailing Address
First Line : 1009 N GEORGETOWN ST
Second Line :
City : ROUND ROCK
State : TX
Zip : 78664-3289
Country : US
Telephone Number : 512-244-8374
Fax Number : 512-244-8371
Provider Business Practice Location Address
First Line : 1009 N GEORGETOWN ST
Second Line :
City : ROUND ROCK
State : TX
Zip : 78664-3289
Country : US
Telephone Number : 512-244-8374
Fax Number : 512-244-8371
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2006
Last Update Date : 07/09/2007

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