Provider Demographics
NPI:1073509006
Name:CRAWFORD, TERRI D (MED, LCSW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:D
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MED, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E BRADFORD PKWY
Mailing Address - Street 2:BURRELL BEHAVIORAL HEALTH
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4264
Mailing Address - Country:US
Mailing Address - Phone:417-269-5400
Mailing Address - Fax:417-269-7512
Practice Address - Street 1:930 S ROBBERSON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-3220
Practice Address - Country:US
Practice Address - Phone:417-761-5540
Practice Address - Fax:417-761-5541
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0021951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490056355Medicaid