MEDICARE: CRAWFORD COUNSELING GROUP

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	101YM0800X	Mental Health Counselor	180004808	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1962482471	OTHER		INDIVIDUAL NPI

General Provider Information

NPI Number	:	1770876963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAWFORD COUNSELING GROUP

Provider Business Mailing Address
First Line	:	2530 CRAWFORD AVE STE 304
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4972
Country	:	US
Telephone Number	:	847-424-9433
Fax Number	:	847-869-8116

Provider Business Practice Location Address
First Line	:	2530 CRAWFORD AVE STE 304
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4972
Country	:	US
Telephone Number	:	847-424-9433
Fax Number	:	847-869-8116

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. PHILIP OSBORNE
Credential	:	LCPC
Telephone Number	:	847-424-9433

Provider Enumeration Date	:	05/20/2011
Last Update Date	:	05/20/2011

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