Provider Demographics
NPI:1205244936
Name:CROCKETT, PATRICIA (LMHC, SOTP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:LMHC, SOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4846
Mailing Address - Country:US
Mailing Address - Phone:253-444-5450
Mailing Address - Fax:253-444-5451
Practice Address - Street 1:1905 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 201
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4846
Practice Address - Country:US
Practice Address - Phone:253-444-5450
Practice Address - Fax:253-444-5451
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFC00000178101Y00000X
WALH00008583101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor