Provider Demographics
NPI:1215112206
Name:CROOK, RUSSELL V, (LPC)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:V,
Last Name:CROOK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 GREEN RIVER TRL
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-6114
Mailing Address - Country:US
Mailing Address - Phone:817-774-7115
Mailing Address - Fax:817-641-7543
Practice Address - Street 1:1100 W WESTHILL DR
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-6133
Practice Address - Country:US
Practice Address - Phone:817-645-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional