Individual provider Active NPI

Keith L Crownover, PHD

  • Mental Health Counselor
  • Albuquerque, NM
National Provider Identifier
1447511605
Registry record updated Nov 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
CCMH0219991 Issued in NM
Practice address
3205 Tahiti St NE
Albuquerque, NM 87111-5342
Phone
(405) 824-9625
NPI assigned
Jun 5, 2012
Last updated
Nov 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LPC0017517 CO
Mental Health Counselor 101YM0800X LPC6141 OK
Mental Health Counselor 101YM0800X CCMH0219991 NM Primary

Addresses

Primary practice location

3205 Tahiti St NE
Albuquerque, NM 87111-5342

Mailing address

3205 Tahiti St NE
Albuquerque, NM 87111-5342
Phone (405) 824-9625

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, NM, CO3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20251208004121 OK Practitioner - Mental Health Counselor 3971097916 Reassigns benefits to 1 organization
I20251208004148 NM Practitioner - Mental Health Counselor 3971097916 Reassigns benefits to 1 organization
I20251208004159 CO Practitioner - Mental Health Counselor 3971097916 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2015
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

PO Box
Dallas, TX 75373

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
LPC0017517COMDMental Health Counselor
CCMH0219991NMMDMental Health Counselor
LPC6141OKMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Sondermind Provider Network LLC Professional CurrentSince Oct 26, 2025 Accepting new patients

Locations

720 S Colorado Blvd
Ph N
Glendale, CO 80246
Phone (833) 988-0589

500 Marquette Ave NW
Ste 1200
Albuquerque, NM 87102
Phone (505) 295-6685

1831 E 71st St
Tulsa, OK 74136
Phone (855) 632-6940

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762732800000",
    "number": "1447511605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 TAHITI ST NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871115342",
            "telephone_number": "405-824-9625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3205 TAHITI ST NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871115342",
            "telephone_number": "405-824-9625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROWNOVER",
        "first_name": "KEITH",
        "middle_name": "L",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-05",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "LPC0017517",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "LPC6141",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CCMH0219991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.