Healthcare Provider Details

I. General information

NPI: 1811144660
Provider Name (Legal Business Name): MARY JEAN CRAWLEY PH. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2008
Last Update Date: 08/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KINGS WAY
AVENAL CA
93204-9708
US

IV. Provider business mailing address

1069 COLUMBUS WAY
LEMOORE CA
93245-9171
US

V. Phone/Fax

Practice location:
  • Phone: 559-386-0587
  • Fax:
Mailing address:
  • Phone: 559-925-8392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: