Provider Demographics
NPI:1043940711
Name:CRAWFORD, MAKAYLA RAE (PLMHP, PLADC)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:RAE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PLMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W R ST
Mailing Address - Street 2:
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153-1859
Mailing Address - Country:US
Mailing Address - Phone:308-520-1771
Mailing Address - Fax:
Practice Address - Street 1:700 W A ST
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-1413
Practice Address - Country:US
Practice Address - Phone:308-289-2746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1980101YA0400X
NE12983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)