MEDICARE: MALISSA K CROWE, LLC

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	34005071A	IN

General Provider Information

NPI Number	:	1811071046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALISSA K CROWE, LLC

Provider Business Mailing Address
First Line	:	1351 S SHARON CHAPEL RD
Second Line	:
City	:	WEST LAFAYETTE BRA
State	:	IN
Zip	:	47906-4342
Country	:	US
Telephone Number	:	765-491-6175
Fax Number	:	765-743-5850

Provider Business Practice Location Address
First Line	:	120 SAGAMORE PKWY W
Second Line	:
City	:	WEST LAFAYETTE BRA
State	:	IN
Zip	:	47906-1569
Country	:	US
Telephone Number	:	765-491-6175
Fax Number	:	765-743-5850

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MALISSA K CROWE
Credential	:	LCSW
Telephone Number	:	765-491-6175

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	08/22/2020

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