Provider Demographics
NPI:1043059587
Name:CROWNOVER, MATTIE ELLE (LMSW)
Entity type:Individual
Prefix:MS
First Name:MATTIE
Middle Name:ELLE
Last Name:CROWNOVER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12880 HILLCREST RD STE J105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1532
Mailing Address - Country:US
Mailing Address - Phone:972-404-3001
Mailing Address - Fax:972-404-3005
Practice Address - Street 1:12880 HILLCREST RD STE J105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1532
Practice Address - Country:US
Practice Address - Phone:972-404-3001
Practice Address - Fax:972-404-3005
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker