MEDICARE: DR. SHANNAN CRAWFORD PSY.D.

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	103TC0700X	Clinical Psychologist	34887	TX

General Provider Information

NPI Number	:	1679875322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNAN CRAWFORD PSY.D.

Provider Business Mailing Address
First Line	:	1664 KELLER PKWY STE 103
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-3760
Country	:	US
Telephone Number	:	817-601-5540
Fax Number	:

Provider Business Practice Location Address
First Line	:	1664 KELLER PKWY STE 103
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-3760
Country	:	US
Telephone Number	:	817-601-5540
Fax Number	:

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

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	07/21/2022

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