Provider Demographics
NPI:1134363161
Name:CROOKSTON, CLARA LOUISE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:LOUISE
Last Name:CROOKSTON
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:PO BOX 856
Mailing Address - Street 2:641 S MAIN ST
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-0856
Mailing Address - Country:US
Mailing Address - Phone:928-536-4117
Mailing Address - Fax:928-536-7626
Practice Address - Street 1:641 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5595
Practice Address - Country:US
Practice Address - Phone:928-536-4117
Practice Address - Fax:928-536-7626
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-125011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical