Provider Demographics
NPI:1083637276
Name:CROW, C DONEL (PH D)
Entity type:Individual
Prefix:
First Name:C DONEL
Middle Name:
Last Name:CROW
Suffix:
Gender:
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 24TH ST STE B10-234
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2300
Mailing Address - Country:US
Mailing Address - Phone:661-747-4896
Mailing Address - Fax:661-424-7859
Practice Address - Street 1:1201 24TH ST STE B110-234
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2300
Practice Address - Country:US
Practice Address - Phone:661-747-4896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSYCH1671103TC0700X
CAPSYCH15399103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical