Provider Demographics
NPI:1902894868
Name:JENSEN CRAWFORD, LETITIA ANN (PHD, LCSW)
Entity type:Individual
Prefix:
First Name:LETITIA
Middle Name:ANN
Last Name:JENSEN CRAWFORD
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:ANN
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LCSW
Mailing Address - Street 1:500 RUSSELL STREET
Mailing Address - Street 2:SUITE 106
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759
Mailing Address - Country:US
Mailing Address - Phone:662-323-6317
Mailing Address - Fax:662-325-7538
Practice Address - Street 1:500 RUSSELL STREET
Practice Address - Street 2:SUITE 106
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
Practice Address - Country:US
Practice Address - Phone:662-323-6317
Practice Address - Fax:662-325-7538
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC07781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical