Provider Demographics
NPI:1417738683
Name:CROWLEY, JIMMY (LCDC)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:
Last Name:CROWLEY
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7509 MENCHACA RD UNIT 301
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-6062
Mailing Address - Country:US
Mailing Address - Phone:512-360-3600
Mailing Address - Fax:
Practice Address - Street 1:7509 MENCHACA RD UNIT 301
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-6062
Practice Address - Country:US
Practice Address - Phone:512-360-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12656101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)