Healthcare Provider Details

I. General information

NPI: 1063245215
Provider Name (Legal Business Name): PATRINA CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9666 OLIVE BLVD STE 330
SAINT LOUIS MO
63132-3035
US

IV. Provider business mailing address

9666 OLIVE BLVD STE 330
SAINT LOUIS MO
63132-3035
US

V. Phone/Fax

Practice location:
  • Phone: 636-317-1197
  • Fax: 833-667-0319
Mailing address:
  • Phone: 636-317-1197
  • Fax: 833-667-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: