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NPI Code Detail

MEDICARE: ILISHA T CRAWFORD-BROWN MS

MEDICARE:   ILISHA T CRAWFORD-BROWN  MS
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1598012403
Entity Type Code : Individual
Provider Name (Legal Business Name) : ILISHA T CRAWFORD-BROWN MS
Provider Business Mailing Address
First Line : 5862 CATALINA LN
Second Line :
City : GREENWOOD
State : FL
Zip : 32443-2290
Country : US
Telephone Number : 850-557-3759
Fax Number :
Provider Business Practice Location Address
First Line : 5862 CATALINA LN
Second Line :
City : GREENWOOD
State : FL
Zip : 32443-2290
Country : US
Telephone Number : 850-557-3759
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2012
Last Update Date : 08/09/2012

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Directions to “ ILISHA T CRAWFORD-BROWN MS” Practice Location

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