Provider Demographics
NPI:1649683376
Name:CROOK, MUNA
Entity type:Individual
Prefix:
First Name:MUNA
Middle Name:
Last Name:CROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 MAIN ST
Mailing Address - Street 2:SUITE 444
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1803
Mailing Address - Country:US
Mailing Address - Phone:208-750-3000
Mailing Address - Fax:
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:SUITE 444
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1803
Practice Address - Country:US
Practice Address - Phone:208-750-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-2908101Y00000X
WALF-60140407106H00000X
WAMA-00024354225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist