Provider Demographics
NPI:1851830608
Name:CRAWFORD, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ELAINE
Other - Last Name:GUYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8011 W PARKWAY BLVD APT 104
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-5673
Mailing Address - Country:US
Mailing Address - Phone:918-853-6185
Mailing Address - Fax:
Practice Address - Street 1:8011 W PARKWAY BLVD APT 104
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-5673
Practice Address - Country:US
Practice Address - Phone:918-853-6185
Practice Address - Fax:918-293-2581
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator