Provider Demographics
NPI:1962114322
Name:CRAWFORD, MICHELLE DENISE (LMHCA)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:DENISE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3662 WINDY BEACH ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-1879
Mailing Address - Country:US
Mailing Address - Phone:219-290-6380
Mailing Address - Fax:
Practice Address - Street 1:5233 HOHMAN
Practice Address - Street 2:
Practice Address - City:HAMOND
Practice Address - State:IN
Practice Address - Zip Code:46320
Practice Address - Country:US
Practice Address - Phone:219-881-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99101189A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN99101189AMedicaid