Provider Demographics
NPI:1508138223
Name:CROUCH, BILLY (MS)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:
Last Name:CROUCH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5312 CHICKASAW RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-1743
Mailing Address - Country:US
Mailing Address - Phone:901-210-0770
Mailing Address - Fax:
Practice Address - Street 1:5312 CHICKASAW RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-1743
Practice Address - Country:US
Practice Address - Phone:901-210-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional