Provider Demographics
NPI:1659463487
Name:CROCKETT, WILLIAM CURTIS (LMHP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CURTIS
Last Name:CROCKETT
Suffix:
Gender:M
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 4TH AVE
Mailing Address - Street 2:#38
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2878
Mailing Address - Country:US
Mailing Address - Phone:308-627-5679
Mailing Address - Fax:308-865-0017
Practice Address - Street 1:4111 4TH AVE
Practice Address - Street 2:#38
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2878
Practice Address - Country:US
Practice Address - Phone:308-627-5679
Practice Address - Fax:308-865-0017
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2836101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health