| Mickey Crothers, Ph.d., LLC | |
|
4330 Golf Ter Suite 213-m Eau Claire WI 54701-4683 | |
| (715) 830-1400 | |
| Not Available |
| Full Name | Mickey Crothers, Ph.d., LLC |
|---|---|
| Speciality | Psychologist |
| Location | 4330 Golf Ter, Eau Claire, Wisconsin |
| Authorized Official Name and Position | Marie K. (mickey) Crothers (MEMBER) |
| Authorized Official Contact | 7158301400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mickey Crothers, Ph.d., LLC 4330 Golf Ter Suite 213-m Eau Claire WI 54701-4683 Ph: (715) 830-1400 | Mickey Crothers, Ph.d., LLC 4330 Golf Ter Suite 213-m Eau Claire WI 54701-4683 Ph: (715) 830-1400 |
| NPI Number | 1467874990 |
|---|---|
| Provider Enumeration Date | 01/17/2014 |
| Last Update Date | 02/18/2014 |
| Medicare PECOS PAC ID | 5294967030 |
|---|---|
| Medicare Enrollment ID | O20140410000764 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467874990 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | () | Secondary |
| 103T00000X | Psychologist | () | Primary |
| 103TC0700X | Psychologist - Clinical | () | Secondary |
| Provider Name | Marie K Crothers |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699728329 PECOS PAC ID: 4183811847 Enrollment ID: I20101207000537 |
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