Provider Demographics
NPI:1619504677
Name:CROWSEY, MISTI (BASE QMHP,CC)
Entity Type:Individual
Prefix:MRS
First Name:MISTI
Middle Name:
Last Name:CROWSEY
Suffix:
Gender:F
Credentials:BASE QMHP,CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8915 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-1717
Mailing Address - Country:US
Mailing Address - Phone:214-351-3490
Mailing Address - Fax:844-625-0357
Practice Address - Street 1:7551 COUNTY ROAD 2829
Practice Address - Street 2:
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75156-7187
Practice Address - Country:US
Practice Address - Phone:903-288-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty