Individual
DAVID HUBERT LARUE CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2201 N. 22ND AVE., SUITE NUMBER A, SHOW LOW, AZ 85901-1587
(928) 537-5696
Mailing address
PO BOX 1587, SHOW LOW, AZ 85902-1587
(928) 537-5696
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-12500
AZ
Other
Enumeration date
07/30/2008
Last updated
07/30/2008
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