Provider Demographics
NPI:1235953936
Name:CROUCH, LAWRENCE RAYMOND (PHD)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:RAYMOND
Last Name:CROUCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:MR
Other - First Name:LARRY
Other - Middle Name:RAYMOND
Other - Last Name:CROUCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:4805 PLEASANT GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1601
Mailing Address - Country:US
Mailing Address - Phone:859-608-6451
Mailing Address - Fax:
Practice Address - Street 1:4805 PLEASANT GROVE ROAD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-1601
Practice Address - Country:US
Practice Address - Phone:859-608-6451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health