Provider Demographics
NPI:1558719971
Name:CROWDER, DEBORAH (EDS, NCSP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:CROWDER
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 DANA DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-8873
Mailing Address - Country:US
Mailing Address - Phone:513-523-0246
Mailing Address - Fax:
Practice Address - Street 1:400 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1168
Practice Address - Country:US
Practice Address - Phone:513-273-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20823330103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool