Provider Demographics
NPI:1386127645
Name:CROUSE, THOMAS MICHAEL (LCSW)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:CROUSE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10626 SCHIRRA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MATHER
Mailing Address - State:CA
Mailing Address - Zip Code:95655-1101
Mailing Address - Country:US
Mailing Address - Phone:916-228-3100
Mailing Address - Fax:916-228-3103
Practice Address - Street 1:10626 SCHIRRA AVE
Practice Address - Street 2:
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655-4121
Practice Address - Country:US
Practice Address - Phone:916-228-3100
Practice Address - Fax:916-228-3103
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW142671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW14267OtherBOARD OF BEHAVIORAL SCIENCES