Healthcare Provider Details

I. General information

NPI: 1679021752
Provider Name (Legal Business Name): LARRY DEAN CRAWFORD JR. LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 FLETCHER PKWY STE 350
LA MESA CA
91942-6103
US

IV. Provider business mailing address

8881 FLETCHER PKWY STE 350
LA MESA CA
91942-6103
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax:
Mailing address:
  • Phone: 858-279-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160449
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number108569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: