Provider Demographics
NPI:1679649305
Name:CROUCH, JOYCE G (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:G
Last Name:CROUCH
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:ALLARDT
Mailing Address - State:TN
Mailing Address - Zip Code:38504
Mailing Address - Country:US
Mailing Address - Phone:931-879-4725
Mailing Address - Fax:931-879-8586
Practice Address - Street 1:205 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556
Practice Address - Country:US
Practice Address - Phone:931-879-4725
Practice Address - Fax:931-879-8586
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001434103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3683864Medicaid
TN0132634OtherBLUE CROSS
3683864Medicare ID - Type Unspecified