Provider Demographics
NPI:1063017242
Name:CROUCH, AUDREY M (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:M
Last Name:CROUCH
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 BARBARA WAY
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-6501
Mailing Address - Country:US
Mailing Address - Phone:214-228-0659
Mailing Address - Fax:
Practice Address - Street 1:301 S ROGERS ST STE 205
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3348
Practice Address - Country:US
Practice Address - Phone:469-297-0682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11772101YA0400X
TX80935101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)