Ian Terry Crocker
Individual provider Active NPI Mental Health Counselor · Mentone, CA
NPI 1215217633 · NPPES record last updated Aug 17, 2011
Key facts
- NPI
- 1215217633
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 9355 Opal Ave
Mentone, CA 92359-9605 - Phone
- (909) 705-5998
- Fax
- (909) 389-9431
- NPI assigned
- Aug 17, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
9355 Opal Ave
Mentone, CA 92359-9605
Mailing address
9355 Opal Ave
Mentone, CA 92359-9605
Phone (909) 705-5998
Other providers in Mentone, CA
- Rachel Cabuhat
- Yaritza Camacho
- Tina Marie Carrillo
- Lisa M Coonrod
- Covenant Health Services
- Maria Rosario Cruz Heredia
- Mohamed M Elhanafy
- Lara Elijah
- Starr Lynette Fox
- Future Stars Youth Services
All providers in Mentone, CA · Mental Health Counselor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.