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NPI Code Detail

MEDICARE: TAMARA D CROWN LCSW

MEDICARE:   TAMARA D CROWN  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
11041C0700XClinical Social Worker1595OK

Other Identifiers

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

General Provider Information

NPI Number : 1588632749
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMARA D CROWN LCSW
Provider Business Mailing Address
First Line : 517 TALONS REACH RUN
Second Line :
City : BERTHOUD
State : CO
Zip : 80513-8701
Country : US
Telephone Number : 405-630-0189
Fax Number : 405-840-3794
Provider Business Practice Location Address
First Line : 517 TALONS REACH RUN
Second Line :
City : BERTHOUD
State : CO
Zip : 80513-8701
Country : US
Telephone Number : 405-630-0189
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 06/10/2024

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