Provider Demographics
NPI:1326624214
Name:CRAWFORD, GENORRIS L (LPN, LPC/MHSP)
Entity Type:Individual
Prefix:
First Name:GENORRIS
Middle Name:L
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LPN, LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 14TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-1164
Mailing Address - Country:US
Mailing Address - Phone:615-210-6229
Mailing Address - Fax:
Practice Address - Street 1:9695 LEBANON RD STE 340
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-5541
Practice Address - Country:US
Practice Address - Phone:833-432-5987
Practice Address - Fax:615-754-4756
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YA0400X
TNLPC0000002224106H00000X, 101YP2500X
TNLPN0000082211164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse