MEDICARE: JUDITH CROP L.P.C.

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	101YP2500X	Professional Counselor	C1921/ACTIVE	OR

General Provider Information

NPI Number	:	1912223173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH CROP L.P.C.

Provider Business Mailing Address
First Line	:	PO BOX 598
Second Line	:
City	:	EAGLE CREEK
State	:	OR
Zip	:	97022-0598
Country	:	US
Telephone Number	:	503-637-3407
Fax Number	:

Provider Business Practice Location Address
First Line	:	24004 SE CRANE RD
Second Line	:
City	:	EAGLE CREEK
State	:	OR
Zip	:	97022-9786
Country	:	US
Telephone Number	:	503-637-3407
Fax Number	:

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

Provider Enumeration Date	:	04/13/2010
Last Update Date	:	04/13/2010

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Directions to “ JUDITH CROP L.P.C.” Practice Location

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