Individual
DR. MICHAEL CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
4316 SE 182ND AVE, GRESHAM, OR 97030-5058
(503) 893-2249
Mailing address
2315 NE FRANCIS CT, GRESHAM, OR 97030-3155
(302) 270-8286
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
Other
Enumeration date
01/27/2015
Last updated
03/02/2022
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