Individual
SAMUEL WILLIAM CROUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PLADC
Contact information
Practice address
921 W 36TH ST, SCOTTSBLUFF, NE 69361-5009
(308) 225-0500
Mailing address
921 W 36TH ST, SCOTTSBLUFF, NE 69361-5009
(308) 225-0500
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
P-1628
NE
101YM0800X
Mental Health Counselor
Primary
11806
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026769300
—
NE
Enumeration date
10/02/2018
Last updated
04/30/2019
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