Malissa K Crowe, LLC
Organization Active NPI Mental Health Counselor · West Lafayette Bra, IN
NPI 1811071046 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1811071046
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 34005071A (IN)
- Legal business name
- MALISSA K CROWE, LLC
- Practice address
- 120 Sagamore Pkwy W
West Lafayette Bra, IN 47906-1569 - Phone
- (765) 491-6175
- Fax
- (765) 743-5850
- NPI assigned
- Oct 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Malissa K Crowe, LCSW
- Title
- Sole Proprietor
- Phone
- (765) 491-6175
Practitioners 2
-
Malissa Kaye Crowe, LCSW
-
Sally Ann Timmons, LCSW, RN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200922001212 | AZ | Part B Supplier - Clinic/Group Practice | 2365448503 |
Receives reassigned benefits from 1 practitioner Practice locations: Tucson, AZ |
National Provider Directory
Locations
142 Sagamore Pkwy W
West Lafayette, IN 47906
Phone (765) 404-6431
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | 34005071A | IN | Yes |
Addresses
Primary practice location
120 Sagamore Pkwy W
West Lafayette Bra, IN 47906-1569
Mailing address
1351 S Sharon Chapel Rd
West Lafayette Bra, IN 47906-4342
Phone (765) 491-6175
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- Hua Li
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- Joyce Lynn Micon
- Barbara Emma Nolan
- Sivaprasad Parnam
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All providers in West Lafayette Bra, IN · Mental Health Counselor in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.