Provider Demographics
NPI:1275878118
Name:CRAWFORD, ROBIN M (MS)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:M
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:M
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:6710 OLD TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46809-2639
Mailing Address - Country:US
Mailing Address - Phone:260-580-3734
Mailing Address - Fax:
Practice Address - Street 1:6710 OLD TRAIL RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46809-2639
Practice Address - Country:US
Practice Address - Phone:260-580-3734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003391A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health