Provider Demographics
NPI: | 1659988251 |
---|---|
Name: | CROWE, MINDY (CDCA) |
Entity Type: | Individual |
Prefix: | |
First Name: | MINDY |
Middle Name: | |
Last Name: | CROWE |
Suffix: | |
Gender: | F |
Credentials: | CDCA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 528 W MARION RD |
Mailing Address - Street 2: | |
Mailing Address - City: | MOUNT GILEAD |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43338-1085 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 614-655-3345 |
Mailing Address - Fax: | 614-317-4689 |
Practice Address - Street 1: | 528 W MARION RD |
Practice Address - Street 2: | |
Practice Address - City: | MOUNT GILEAD |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43338-1085 |
Practice Address - Country: | US |
Practice Address - Phone: | 614-339-0806 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2020-09-28 |
Last Update Date: | 2023-06-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
175T00000X | ||
OH | CDCA.174138 | 101YA0400X |
OH | 171M00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No | 175T00000X | Other Service Providers | Peer Specialist | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 2910854 | Medicaid |