MEDICARE: CAMILLE CRAWFORD CCC SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1629367313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMILLE CRAWFORD CCC SERVICES

Provider Business Mailing Address
First Line	:	4417 OASIS PLAINS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89085-2334
Country	:	US
Telephone Number	:	702-515-2060
Fax Number	:	702-515-2060

Provider Business Practice Location Address
First Line	:	4417 OASIS PLAINS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89085-2334
Country	:	US
Telephone Number	:	702-515-2060
Fax Number	:	702-515-2060

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. CAMILLE JEAN CRAWFORD
Credential	:	PHD
Telephone Number	:	702-515-2060

Provider Enumeration Date	:	04/03/2011
Last Update Date	:	04/03/2011

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