Healthcare Provider Details

I. General information

NPI: 1104457928
Provider Name (Legal Business Name): TRISTIN M.H. CRAWLEY QMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 CHERRY ST
TOLEDO OH
43608-2667
US

IV. Provider business mailing address

2116 TEDROW RD APT 36
TOLEDO OH
43614-3875
US

V. Phone/Fax

Practice location:
  • Phone: 419-244-3053
  • Fax: 419-244-1100
Mailing address:
  • Phone: 419-208-4734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2405908
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: