Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003195835 |
---|---|
Provider Name | Mr. John Bentley Crowley |
First Address | Las Vegas, NV 89106-2452 |
Second Address | Las Vegas, NV 89106-2452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2011 |
Last Update Date | 10/08/2011 |