MEDICARE: MRS. ELEANOR CATHERINE CRAWFORD MFT INTERN

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	81805	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51239	OTHER	CA	MFTI LICENSE

General Provider Information

NPI Number	:	1881706216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELEANOR CATHERINE CRAWFORD MFT INTERN

Provider Business Mailing Address
First Line	:	101 PROVIDENCE MINE RD
Second Line	:	SUITE 106C
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-2939
Country	:	US
Telephone Number	:	530-559-8902
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 PROVIDENCE MINE RD
Second Line	:	106C
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-2939
Country	:	US
Telephone Number	:	530-559-8902
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/15/2015

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