Provider Demographics
NPI:1194869313
Name:CROUCH, PIERRE-CEDRIC BERNARD (PHD,ANP-BC,PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:PIERRE-CEDRIC
Middle Name:BERNARD
Last Name:CROUCH
Suffix:
Gender:M
Credentials:PHD,ANP-BC,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 MISSION ST
Mailing Address - Street 2:UNIT 643
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2412
Mailing Address - Country:US
Mailing Address - Phone:415-863-2251
Mailing Address - Fax:
Practice Address - Street 1:2119 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1522
Practice Address - Country:US
Practice Address - Phone:503-427-8006
Practice Address - Fax:503-741-8079
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA581556163W00000X
OR202002074RN163W00000X
CA17368363L00000X, 363LA2200X, 363LP0808X
OR202004463NP-PP363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health