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Individual

JOHN PAUL CROCKETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LAC

Contact information

Practice address
9225 N 3RD ST STE 102, PHOENIX, AZ 85020-2455
(480) 531-6636
Mailing address
9225 N 3RD ST STE 102, PHOENIX, AZ 85020-2455
(480) 531-6636

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LAC-18633
AZ

Other

Enumeration date
05/21/2021
Last updated
05/21/2021
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