Provider Demographics
NPI:1821696063
Name:CROWSON, BRENT (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:CROWSON
Suffix:
Gender:M
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:BRENT
Other - Middle Name:WAYNE
Other - Last Name:CROWSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:23602 ENCHANTED PATH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-4323
Mailing Address - Country:US
Mailing Address - Phone:719-502-1680
Mailing Address - Fax:
Practice Address - Street 1:23602 ENCHANTED PATH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-4323
Practice Address - Country:US
Practice Address - Phone:719-502-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82298101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional