Provider Demographics
NPI:1689602559
Name:CROWLEY, MICHAEL (LSCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CROWLEY
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8929 BLUEJACKET ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1991
Mailing Address - Country:US
Mailing Address - Phone:913-677-3553
Mailing Address - Fax:913-677-3282
Practice Address - Street 1:8929 BLUEJACKET ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1991
Practice Address - Country:US
Practice Address - Phone:913-677-3553
Practice Address - Fax:913-677-3282
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100240930AMedicaid
KSD12000014Medicare UPIN