DEPARTMENT OF INSURANCE

Name	Crouch, Justin	DOIID	1226767	NAIC NPN	20435567

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Active	Non Resident	Agent	Personal Lines	1/4/2023		8/31/2024
Active	Non Resident	Agent	Health	8/30/2022		8/31/2024

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	06/15/2024	08/31/2024

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Business / Home Office	12821 Stratford Dr Apt 216 Oklahoma City, OK 731208477
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(719) 799-8610