Healthcare Provider Details

I. General information

NPI: 1356257026
Provider Name (Legal Business Name): JILL T CRAWFORD M.ED, LCDC, LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16049 PLASTER CIR
CONROE TX
77303-3327
US

IV. Provider business mailing address

16049 PLASTER CIR
CONROE TX
77303-3327
US

V. Phone/Fax

Practice location:
  • Phone: 603-674-1025
  • Fax: 555-555-5555
Mailing address:
  • Phone: 603-674-1025
  • Fax: 555-555-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number103551
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: