Provider Demographics
NPI:1083637276
Name:CROW, C DONEL (PH D)
Entity Type:Individual
Prefix:
First Name:C DONEL
Middle Name:
Last Name:CROW
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MING AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4619
Mailing Address - Country:US
Mailing Address - Phone:661-323-5579
Mailing Address - Fax:661-323-5575
Practice Address - Street 1:1201 24TH ST STE B110-234
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2300
Practice Address - Country:US
Practice Address - Phone:661-747-4896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSYCH1671103T00000X
CAPSYCH15399103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist