Provider Demographics
NPI:1558472399
Name:CROW, PHILLIP (CCP)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:CROW
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 N MAY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6641
Mailing Address - Country:US
Mailing Address - Phone:405-604-5613
Mailing Address - Fax:405-601-3750
Practice Address - Street 1:9110 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73131-7238
Practice Address - Country:US
Practice Address - Phone:405-604-5613
Practice Address - Fax:405-601-3750
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLP8174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist