Provider Demographics
NPI:1952171266
Name:CROWES NEST OUTPATIENT LLC
Entity Type:Organization
Organization Name:CROWES NEST OUTPATIENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WOOLARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:561-346-2550
Mailing Address - Street 1:17356 NORTHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-6045
Mailing Address - Country:US
Mailing Address - Phone:530-448-4555
Mailing Address - Fax:
Practice Address - Street 1:17400 NORTHWOODS BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-6062
Practice Address - Country:US
Practice Address - Phone:530-448-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health