Provider Demographics
NPI:1740738012
Name:DR. JEFFREY CROW PSYCHOTHERAPIST, INC.
Entity Type:Organization
Organization Name:DR. JEFFREY CROW PSYCHOTHERAPIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MFC
Authorized Official - Phone:951-737-9313
Mailing Address - Street 1:4160 TEMESCAL CANYON RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-4625
Mailing Address - Country:US
Mailing Address - Phone:951-737-9313
Mailing Address - Fax:951-696-5222
Practice Address - Street 1:4160 TEMESCAL CANYON RD
Practice Address - Street 2:SUITE 309
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-4625
Practice Address - Country:US
Practice Address - Phone:951-737-9313
Practice Address - Fax:951-696-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty