Healthcare Provider Details

I. General information

NPI: 1710497821
Provider Name (Legal Business Name): CHRISTY R CRAWFORD MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISY R COOPER PLPC

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N MASON ST
CARROLLTON MO
64633-2247
US

IV. Provider business mailing address

1300 E BRADFORD PKWY
SPRINGFIELD MO
65804-4264
US

V. Phone/Fax

Practice location:
  • Phone: 660-542-1403
  • Fax: 660-542-3141
Mailing address:
  • Phone: 417-761-5000
  • Fax: 417-761-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2016044485
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: