Healthcare Provider Details

I. General information

NPI: 1043334899
Provider Name (Legal Business Name): MARY ELIZABETH CRANE LCPC, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73265 CONFEDERATED WAY
PENDLETON OR
97801-0160
US

IV. Provider business mailing address

211 NW 10TH ST
PENDLETON OR
97801-1561
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax: 541-278-7572
Mailing address:
  • Phone: 541-278-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-3458
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW-1306
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC2405
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: