| Doctor Name: | MARGAUX EDWARDS CROCKETT |
| NPI Number: | 1205220191 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | LPC-5683 |
| Business Practice Address: | 125 Commerce St Suite B Mccall, ID - 836385192 |
| Business Phone Number: | 8886347817 |
| Business Fax Number: | |
| Mailing Address: | Po Box 653, DONNELLY |
| State: | ID |
| Postal Code: | 836150653 |
| Phone Number: | 2088602488 |
| Fax Number: | |
| NPI Enumeration Date: | 03/27/2015 |
| NPI Last Update Date: | 03/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC-5683 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |