MEDICARE: MRS. DINAFAY CRANDELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	73752	CA

General Provider Information

NPI Number	:	1215281589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DINAFAY CRANDELL

Provider Business Mailing Address
First Line	:	PO BOX 10291
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93389-0291
Country	:	US
Telephone Number	:	661-330-1266
Fax Number	:	661-835-8969

Provider Business Practice Location Address
First Line	:	5121 STOCKDALE HWY STE 200
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-2664
Country	:	US
Telephone Number	:	661-241-5040
Fax Number	:	661-241-5047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2012
Last Update Date	:	01/09/2013

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