MEDICARE: MRS. JUANITA YVONNE CRAWFORD

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1396023305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUANITA YVONNE CRAWFORD

Provider Business Mailing Address
First Line	:	6313 NW 82ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-4638
Country	:	US
Telephone Number	:	405-367-7541
Fax Number	:

Provider Business Practice Location Address
First Line	:	6313 NW 82ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-4638
Country	:	US
Telephone Number	:	405-367-7541
Fax Number	:

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

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	07/16/2014

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