Provider Demographics
NPI:1982753679
Name:CROWE, MICHAEL GABRIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GABRIEL
Last Name:CROWE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 3RD AVE S
Mailing Address - Street 2:CH19, ROOM 218P
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0002
Mailing Address - Country:US
Mailing Address - Phone:205-996-6419
Mailing Address - Fax:
Practice Address - Street 1:1530 3RD AVE S
Practice Address - Street 2:CH19, ROOM 218P
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0002
Practice Address - Country:US
Practice Address - Phone:205-996-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1405103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist