MEDICARE: MS. DELORES LEE CRAWFORD M.A. L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	757435	AZ
2	101YM0800X	Mental Health Counselor	LPC-15548	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336332279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DELORES LEE CRAWFORD M.A. L.P.C.

Provider Business Mailing Address
First Line	:	2182 MCCULLOCH BLVD N STE 3
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6880
Country	:	US
Telephone Number	:	928-600-5497
Fax Number	:	888-276-8290

Provider Business Practice Location Address
First Line	:	2182 MCCULLOCH BLVD N STE 3
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6880
Country	:	US
Telephone Number	:	928-600-5497
Fax Number	:	888-276-8290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	12/19/2017

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