Provider Demographics
NPI:1104457928
Name:CRAWLEY, TRISTIN MH (QMHS)
Entity type:Individual
Prefix:
First Name:TRISTIN
Middle Name:MH
Last Name:CRAWLEY
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 TEDROW RD APT 36
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3875
Mailing Address - Country:US
Mailing Address - Phone:419-208-4734
Mailing Address - Fax:
Practice Address - Street 1:2460 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2667
Practice Address - Country:US
Practice Address - Phone:419-244-3053
Practice Address - Fax:419-244-1100
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHC.2405908101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator