Provider Demographics
NPI:1063662450
Name:CROUCH, KAREN LYN (MA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LYN
Last Name:CROUCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LYN
Other - Last Name:SHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:211B WAYNE STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3132
Mailing Address - Country:US
Mailing Address - Phone:931-490-1424
Mailing Address - Fax:931-560-3072
Practice Address - Street 1:321 W 7TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3132
Practice Address - Country:US
Practice Address - Phone:931-490-1400
Practice Address - Fax:931-490-1402
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TNLPC0000003280101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health