Provider Demographics
NPI:1427408509
Name:CROWELL, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:CROWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6659 HARBOUR BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-5579
Mailing Address - Country:US
Mailing Address - Phone:850-819-2583
Mailing Address - Fax:386-767-4319
Practice Address - Street 1:6659 HARBOUR BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-5579
Practice Address - Country:US
Practice Address - Phone:850-819-2583
Practice Address - Fax:386-767-4319
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-07-3228103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst