=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770876963
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRAWFORD COUNSELING GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2011
-----------------------------------------------------
Last Update Date | 05/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2530 CRAWFORD AVE STE 304
-----------------------------------------------------
City | EVANSTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60201-4972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-424-9433
-----------------------------------------------------
Fax | 847-869-8116
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2530 CRAWFORD AVE STE 304
-----------------------------------------------------
City | EVANSTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60201-4972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-424-9433
-----------------------------------------------------
Fax | 847-869-8116
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | DR. PHILIP OSBORNE
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 847-424-9433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 180004808
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------