Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 1209 | KS |
N | 103T00000X | Psychologist | 1209 | KS |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1209 | KS |
Y | 103G00000X | Clinical Psychologist | 1209 | KS |
Y | 103TC0700X | Clinical Psychologist | 1209 | KS |
N | 103TH0100X | Health Service | 1209 | KS |
N | 103TP2701X | Group Psychotherapist | 1209 | KS |
NPI | 1003859042 |
---|---|
Provider Name | Dr. Jeremy Paul Crosby |
First Address | Wichita, KS 67218-1607 |
Second Address | Wichita, KS 67208-4513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 20/12/2021 |