Healthcare Provider Details

I. General information

NPI: 1194342956
Provider Name (Legal Business Name): KELLY CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 MOBILE HWY
PENSACOLA FL
32526-1256
US

IV. Provider business mailing address

5807 DAHOON DR
PENSACOLA FL
32526-3245
US

V. Phone/Fax

Practice location:
  • Phone: 850-266-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH23839
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: