Provider Demographics
NPI:1194005900
Name:CROW, NICHOLUS JORDON (MS)
Entity Type:Individual
Prefix:
First Name:NICHOLUS
Middle Name:JORDON
Last Name:CROW
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 OSPREY HTS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-6016
Mailing Address - Country:US
Mailing Address - Phone:210-412-5564
Mailing Address - Fax:
Practice Address - Street 1:1419 OSPREY HTS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-6016
Practice Address - Country:US
Practice Address - Phone:210-412-5564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health