Healthcare Provider Details

I. General information

NPI: 1861722308
Provider Name (Legal Business Name): BERNADINE O. CRAWFORD L.P.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 ANTHONY DR SUITE 3B
ANTHONY NM
88021-9346
US

IV. Provider business mailing address

3120 DYER ST
LAS CRUCES NM
88011-4802
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-5290
  • Fax: 575-882-1879
Mailing address:
  • Phone: 575-532-9628
  • Fax: 575-532-9628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4079
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11860
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number285834
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: