Healthcare Provider Details

I. General information

NPI: 1922575372
Provider Name (Legal Business Name): KIMBERLY CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 APPLE TREE DR
IONIA MI
48846-7506
US

IV. Provider business mailing address

375 APPLE TREE DR
IONIA MI
48846-7506
US

V. Phone/Fax

Practice location:
  • Phone: 616-527-1790
  • Fax:
Mailing address:
  • Phone: 616-527-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016388
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: