Provider Demographics
NPI:1427610609
Name:CROUCH, TAMARA MAE
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:MAE
Last Name:CROUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 CAMELOT WAY
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-2640
Mailing Address - Country:US
Mailing Address - Phone:775-304-4474
Mailing Address - Fax:
Practice Address - Street 1:664 CAMELOT WAY
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-2640
Practice Address - Country:US
Practice Address - Phone:775-304-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician