Provider Demographics
NPI:1568001915
Name:MEGHAN CRAWFORD, PSYD, LLC
Entity type:Organization
Organization Name:MEGHAN CRAWFORD, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:626-888-1463
Mailing Address - Street 1:5200 MEADOWS ROAD
Mailing Address - Street 2:STE 150
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:626-888-1463
Mailing Address - Fax:503-974-0936
Practice Address - Street 1:4850 LOST CREEK DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-9269
Practice Address - Country:US
Practice Address - Phone:626-888-1463
Practice Address - Fax:503-974-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500721557Medicaid