Provider Demographics
NPI:1902134117
Name:CROWLEY, LARRY CRESTON JR (LICENSED MENTAL HEAL)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:CRESTON
Last Name:CROWLEY
Suffix:JR
Gender:M
Credentials:LICENSED MENTAL HEAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2846 45TH LOOP SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4822
Mailing Address - Country:US
Mailing Address - Phone:360-556-0258
Mailing Address - Fax:
Practice Address - Street 1:2846 45TH LOOP SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-4822
Practice Address - Country:US
Practice Address - Phone:360-556-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-28
Last Update Date:2009-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 00006539101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health