Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | KY1074 | KY |
NPI | 1033250006 |
---|---|
Provider Name | Dr. Thomas Joseph Crotty |
First Address | Paintsville, KY 41240-0727 |
Second Address | Prestonsburg, KY 41653-7932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89000970 | (05) | KY |
Q11494 | (02) | KY |