Provider Demographics
NPI:1790903458
Name:CROUCH, STEVEN RUSSELL
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RUSSELL
Last Name:CROUCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7070 SCHIRRA CT STE 200
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-2122
Mailing Address - Country:US
Mailing Address - Phone:661-834-7564
Mailing Address - Fax:
Practice Address - Street 1:7070 SCHIRRA CT STE 200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-2122
Practice Address - Country:US
Practice Address - Phone:661-834-7564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33107106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist