Healthcare Provider Details

I. General information

NPI: 1669808713
Provider Name (Legal Business Name): ELIZABETH MARIE CRAWFORD MA COUNSELING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W PERKINS ST STE 107
UKIAH CA
95482-4858
US

IV. Provider business mailing address

416 OAK PARK AVE
UKIAH CA
95482-5325
US

V. Phone/Fax

Practice location:
  • Phone: 707-272-1011
  • Fax: 707-900-8192
Mailing address:
  • Phone: 707-634-3300
  • Fax: 707-900-8192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number125828
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT89147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: