Provider Demographics
NPI:1205194032
Name:CROTTS, CARRIE (LMFT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:CROTTS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:4908 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1901
Practice Address - Country:US
Practice Address - Phone:515-280-4930
Practice Address - Fax:515-309-0686
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIN PROCESSOtherWELLMARK BCBS
IAIN PROCESSMedicaid
IAIN PROCESSMedicaid