MEDICARE: MRS. MARY EMMA CRENSHAW LISW,LICDC

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	0600066	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	976149	OH

General Provider Information

NPI Number	:	1982971263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY EMMA CRENSHAW LISW,LICDC

Provider Business Mailing Address
First Line	:	5504 STATE RD
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-2250
Country	:	US
Telephone Number	:	216-773-2503
Fax Number	:

Provider Business Practice Location Address
First Line	:	12395 MCCRACKEN RD STE A-UP
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-2967
Country	:	US
Telephone Number	:	216-587-6727
Fax Number	:

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

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	04/11/2025

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