Provider Demographics
NPI:1376689596
Name:CROSBY, RALPH D (MA, LIMHP, PC)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:D
Last Name:CROSBY
Suffix:
Gender:M
Credentials:MA, LIMHP, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W KOENIG ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-6036
Mailing Address - Country:US
Mailing Address - Phone:308-380-5478
Mailing Address - Fax:308-382-7830
Practice Address - Street 1:305 W KOENIG ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-6036
Practice Address - Country:US
Practice Address - Phone:308-380-5478
Practice Address - Fax:308-382-7830
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2717101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100261164500Medicaid