Active NPI
Jack Crownover, MA, LPC
- Professional Counselor
- Georgetown, TX
National Provider Identifier
1528821972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 94119
- Practice address
- 117 Red Rose Dr
Georgetown, TX 78628-2044 - Phone
- (512) 791-6229
- NPI assigned
- Jan 30, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 94119 | TX | Primary |
| Counselor | 101Y00000X | 94119 | TX | |
| Mental Health Counselor | 101YM0800X | 94119 | TX |
Addresses
Primary practice location
117 Red Rose Dr
Georgetown, TX 78628-2044
Mailing address
3932 Santiam Pass Way NE Apt 101
Salem, OR 97305-4036
Phone (512) 791-6229
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260504007943 | TX | Practitioner - Mental Health Counselor | 9537637921 | Practice locations: Georgetown, TX |
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
Georgetown, TX 78628
Phone (512) 791-6229
3932 Santiam Pass Way NE
Apt 101
Salem, OR 97305-4036
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 94119 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773878400000",
"number": "1528821972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3932 SANTIAM PASS WAY NE APT 101",
"city": "SALEM",
"state": "OR",
"postal_code": "973054036",
"telephone_number": "512-791-6229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 RED ROSE DR",
"city": "GEORGETOWN",
"state": "TX",
"postal_code": "786282044",
"telephone_number": "512-791-6229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROWNOVER",
"first_name": "JACK",
"credential": "MA, LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-01-30",
"last_updated": "2026-03-19",
"certification_date": "2026-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "94119",
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "94119",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "94119",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Georgetown, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.