Provider Demographics
NPI:1316909617
Name:CRAWFORD, PERRY NEAL (PHD, LPC, LADC, NCC)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:NEAL
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:PHD, LPC, LADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 TETON DR
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-6706
Mailing Address - Country:US
Mailing Address - Phone:760-380-4044
Mailing Address - Fax:760-380-6469
Practice Address - Street 1:ARMY SUBSTANCE ABUSE PROGRAM CLINIC
Practice Address - Street 2:MARY E. WALKER CENTER
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-5090
Practice Address - Country:US
Practice Address - Phone:760-380-4044
Practice Address - Fax:760-380-6469
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCOUN 306101Y00000X
NV588101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV588OtherALCOHOL AND DRUG TRTMNT
ID306OtherPROFESSIONAL COUNSELOR