Provider Demographics
NPI:1801074356
Name:CROWLEY, LANCE JOHN (MA, LADC)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:JOHN
Last Name:CROWLEY
Suffix:
Gender:M
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 US HIGHWAY 395 S
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5265
Mailing Address - Country:US
Mailing Address - Phone:775-721-8463
Mailing Address - Fax:775-783-8080
Practice Address - Street 1:1528 US HIGHWAY 395 S
Practice Address - Street 2:SUITE 250
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5265
Practice Address - Country:US
Practice Address - Phone:775-721-8463
Practice Address - Fax:775-783-8080
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV773101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)