Provider Demographics
NPI:1588170682
Name:CRAWFORD, TERESSA (EDS LPCC)
Entity type:Individual
Prefix:
First Name:TERESSA
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:EDS LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6407 BARDSTOWN RD STE 274
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3040
Mailing Address - Country:US
Mailing Address - Phone:502-512-2895
Mailing Address - Fax:502-855-4970
Practice Address - Street 1:12700 TOWNEPARK WAY STE 309
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2381
Practice Address - Country:US
Practice Address - Phone:502-512-2895
Practice Address - Fax:502-855-4970
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10378101YP2500X
KY264410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
129815OtherKENTUCKY STATE LICENSCE