Healthcare Provider Details

I. General information

NPI: 1629066865
Provider Name (Legal Business Name): SHAWN MICHAEL CRAWFORD M.A., L.P.C.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 UPTOWN BLVD NE
ALBUQUERQUE NM
87110-4162
US

IV. Provider business mailing address

1360 ACAPULCO RD NE
RIO RANCHO NM
87144-6449
US

V. Phone/Fax

Practice location:
  • Phone: 505-237-4093
  • Fax:
Mailing address:
  • Phone: 970-371-8683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0180181
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: