Provider Demographics
NPI:1588992432
Name:CROUCH, PATRICK LOGAN (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:LOGAN
Last Name:CROUCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 DORCAS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-1137
Mailing Address - Country:US
Mailing Address - Phone:402-342-4411
Mailing Address - Fax:402-345-1789
Practice Address - Street 1:819 DORCAS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-1137
Practice Address - Country:US
Practice Address - Phone:402-342-4411
Practice Address - Fax:402-345-1789
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional