Healthcare Provider Details

I. General information

NPI: 1073509006
Provider Name (Legal Business Name): TERRI D CRAWFORD MED, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S ROBBERSON AVE
SPRINGFIELD MO
65806-3220
US

IV. Provider business mailing address

1300 E BRADFORD PKWY BURRELL BEHAVIORAL HEALTH
SPRINGFIELD MO
65804-4264
US

V. Phone/Fax

Practice location:
  • Phone: 417-761-5540
  • Fax: 417-761-5541
Mailing address:
  • Phone: 417-269-5400
  • Fax: 417-269-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002195
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: