Healthcare Provider Details

I. General information

NPI: 1538095401
Provider Name (Legal Business Name): CHELSEA CHEYENNE CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 S SHERIDAN RD
TULSA OK
74145-5712
US

IV. Provider business mailing address

1623 S COLUMBIA PL
TULSA OK
74104-5905
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-4008
  • Fax:
Mailing address:
  • Phone: 918-694-4712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12210
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number12210
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: