Provider Demographics
NPI:1609101187
Name:DR. MARK H CROWELL PLLC
Entity type:Organization
Organization Name:DR. MARK H CROWELL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:CROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:731-736-1874
Mailing Address - Street 1:1385 S HIGHLAND AVE
Mailing Address - Street 2:SUITE B6
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-7580
Mailing Address - Country:US
Mailing Address - Phone:731-736-1874
Mailing Address - Fax:731-736-1884
Practice Address - Street 1:1385 S HIGHLAND AVE
Practice Address - Street 2:SUITE B6
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-7580
Practice Address - Country:US
Practice Address - Phone:731-736-1874
Practice Address - Fax:731-736-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000003871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty