Provider Demographics
NPI:1215454459
Name:CRAWFORD COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:CRAWFORD COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:928-600-5497
Mailing Address - Street 1:2182 MCCULLOCH BLVD N STE 3
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6880
Mailing Address - Country:US
Mailing Address - Phone:928-600-5497
Mailing Address - Fax:888-276-8290
Practice Address - Street 1:2182 MCCULLOCH BLVD N STE 3
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6880
Practice Address - Country:US
Practice Address - Phone:928-600-5497
Practice Address - Fax:888-276-8290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15548251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ079113Medicaid