Provider Demographics
NPI:1780132126
Name:CROWE, KRISTA (PSYD)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:CROWE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1615 LANCASTER DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-2111
Mailing Address - Country:US
Mailing Address - Phone:817-421-0279
Mailing Address - Fax:
Practice Address - Street 1:1615 LANCASTER DR
Practice Address - Street 2:SUITE 150
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-2111
Practice Address - Country:US
Practice Address - Phone:817-421-0279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37402103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical