Provider Demographics
NPI:1093269292
Name:CRANDELL, TODD PRENTICE (LPCC, LCDCIII)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:PRENTICE
Last Name:CRANDELL
Suffix:
Gender:M
Credentials:LPCC, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-0160
Mailing Address - Country:US
Mailing Address - Phone:419-344-5383
Mailing Address - Fax:
Practice Address - Street 1:5800 MONROE ST.
Practice Address - Street 2:BUILDING D SUITE 4
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-0160
Practice Address - Country:US
Practice Address - Phone:419-344-5383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0602167101Y00000X, 101YM0800X
OH081152101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH081152OtherLCDCIII
OHE0602167OtherLPCC