Provider Demographics
NPI:1306866009
Name:CROUCH, PAUL E
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:CROUCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 SW 101ST TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-4604
Mailing Address - Country:US
Mailing Address - Phone:352-215-9734
Mailing Address - Fax:352-332-9734
Practice Address - Street 1:310 NW 76TH DR
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-1593
Practice Address - Country:US
Practice Address - Phone:352-215-9734
Practice Address - Fax:352-332-9734
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW21461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical