Provider Demographics
NPI:1841070430
Name:CROWELL, ELLYN L
Entity type:Individual
Prefix:
First Name:ELLYN
Middle Name:L
Last Name:CROWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELLYN
Other - Middle Name:L
Other - Last Name:CROWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:105 E SHADOWBEND AVE
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3859
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 E SHADOWBEND AVE
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3859
Practice Address - Country:US
Practice Address - Phone:713-893-3906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician