Provider Demographics
NPI:1316657075
Name:CRAWFORD, MIRANDA LYNN (BA, MS)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:LYNN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:BA, MS
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Mailing Address - Street 1:1301 PLAINVIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TX
Mailing Address - Zip Code:76380
Mailing Address - Country:US
Mailing Address - Phone:940-704-8386
Mailing Address - Fax:
Practice Address - Street 1:2410 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4033
Practice Address - Country:US
Practice Address - Phone:940-247-2322
Practice Address - Fax:940-324-8529
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral