=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528158961
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANICE MARLENE CRAWFORD M.S. MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 MARIN ST SUITE 103
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91360-4260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-494-4086
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 SHIRLEY DR
-----------------------------------------------------
City | NEWBURY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91320-3041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-498-3890
-----------------------------------------------------
Fax | 805-498-3890
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC34367
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------