Provider Demographics
NPI:1942899034
Name:CROCKET, ROBERT KEITH
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:KEITH
Last Name:CROCKET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3147 CUSTER DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4020
Mailing Address - Country:US
Mailing Address - Phone:859-477-0855
Mailing Address - Fax:859-479-1090
Practice Address - Street 1:3147 CUSTER DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4020
Practice Address - Country:US
Practice Address - Phone:859-477-0855
Practice Address - Fax:859-479-1090
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health