Provider Demographics
NPI:1104966266
Name:KAREN CREWS
Entity type:Organization
Organization Name:KAREN CREWS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:936-203-5078
Mailing Address - Street 1:89 APRIL WIND DR S
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5966
Mailing Address - Country:US
Mailing Address - Phone:936-203-5078
Mailing Address - Fax:936-588-1636
Practice Address - Street 1:89 APRIL WIND DR S
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5966
Practice Address - Country:US
Practice Address - Phone:936-203-5078
Practice Address - Fax:936-588-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13716251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX066009403Medicaid