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NPI Code Detail

MEDICARE: ROBERT KEITH CROCKET

MEDICARE: ROBERT KEITH CROCKET
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1942899034
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT KEITH CROCKET
Provider Business Mailing Address
First Line : 3147 CUSTER DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40517-4020
Country : US
Telephone Number : 859-477-0855
Fax Number : 859-479-1090
Provider Business Practice Location Address
First Line : 3147 CUSTER DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40517-4020
Country : US
Telephone Number : 859-477-0855
Fax Number : 859-479-1090
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2021
Last Update Date : 08/08/2025

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