Provider Demographics
NPI:1053179937
Name:CROUCH, AMBER MICHELLE (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:MICHELLE
Last Name:CROUCH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 ACADEMY CIR STE 203
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1600
Mailing Address - Country:US
Mailing Address - Phone:719-205-0184
Mailing Address - Fax:888-334-6487
Practice Address - Street 1:2121 ACADEMY CIR STE 203
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1600
Practice Address - Country:US
Practice Address - Phone:850-699-4190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0999726-NP363LP0808X
CORN.1621768163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty