Provider Demographics
NPI:1609337906
Name:CROY, TIMOTHY WAYNE (MS, CAC II)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:WAYNE
Last Name:CROY
Suffix:
Gender:M
Credentials:MS, CAC II
Other - Prefix:
Other - First Name:TIMOTHY
Other - Middle Name:WAYNE
Other - Last Name:CASTRO CROY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12487 E AMHERST CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3305
Mailing Address - Country:US
Mailing Address - Phone:720-498-5613
Mailing Address - Fax:
Practice Address - Street 1:10699 MELODY DR STE 2
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4131
Practice Address - Country:US
Practice Address - Phone:303-252-4179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0008498101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty