Healthcare Provider Details

I. General information

NPI: 1093584336
Provider Name (Legal Business Name): KEYARRA ELYCE CRAWFORD RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5160 VILLAGE CREEK DR
PLANO TX
75093-4498
US

IV. Provider business mailing address

5160 VILLAGE CREEK DR
PLANO TX
75093-4498
US

V. Phone/Fax

Practice location:
  • Phone: 682-324-9376
  • Fax:
Mailing address:
  • Phone: 682-324-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number23-318922
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: