Healthcare Provider Details

I. General information

NPI: 1982975413
Provider Name (Legal Business Name): MINNIE JOYCE CRAWFORD L.P.C., L.M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HICKORY ST
VIDALIA LA
71373-3315
US

IV. Provider business mailing address

120 HIGHWAY 921
CLAYTON LA
71326-4701
US

V. Phone/Fax

Practice location:
  • Phone: 318-372-3134
  • Fax: 318-336-7112
Mailing address:
  • Phone: 318-389-6722
  • Fax: 318-389-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2542
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: