MEDICARE: KRISTEN KERRY CROWE

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	101YM0800X	Mental Health Counselor	5451	CA
2	225600000X	Dance Therapist	1267	CA
3	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5451	OTHER	CA	BOARD OF BEHAVIORAL SCIENCE

General Provider Information

NPI Number	:	1285929984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN KERRY CROWE

Provider Business Mailing Address
First Line	:	1509 OBISPO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-1724
Country	:	US
Telephone Number	:	714-614-6574
Fax Number	:

Provider Business Practice Location Address
First Line	:	2904 W SUNSET BLVD STE 6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-7308
Country	:	US
Telephone Number	:	213-259-3793
Fax Number	:

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

Provider Enumeration Date	:	06/10/2011
Last Update Date	:	11/22/2022

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Directions to “ KRISTEN KERRY CROWE ” Practice Location

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