Provider Demographics
NPI:1134194301
Name:CROOK, MARY KATHLEEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHLEEN
Last Name:CROOK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-8245
Mailing Address - Country:US
Mailing Address - Phone:775-867-5329
Mailing Address - Fax:775-867-5329
Practice Address - Street 1:40 E CENTER ST
Practice Address - Street 2:STE 6
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3475
Practice Address - Country:US
Practice Address - Phone:775-217-2117
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01740-C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health