Healthcare Provider Details

I. General information

NPI: 1336332279
Provider Name (Legal Business Name): DELORES LEE CRAWFORD M.A. L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2182 MCCULLOCH BLVD N STE 3
LAKE HAVASU CITY AZ
86403-6880
US

IV. Provider business mailing address

2182 MCCULLOCH BLVD N STE 3
LAKE HAVASU CITY AZ
86403-6880
US

V. Phone/Fax

Practice location:
  • Phone: 928-600-5497
  • Fax: 888-276-8290
Mailing address:
  • Phone: 928-600-5497
  • Fax: 888-276-8290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-15548
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number757435
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: