Provider Demographics
NPI:1336332279
Name:CRAWFORD, DELORES LEE (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:DELORES
Middle Name:LEE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2182 MCCULLOCH BLVD N STE 3
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6880
Mailing Address - Country:US
Mailing Address - Phone:928-600-5497
Mailing Address - Fax:888-276-8290
Practice Address - Street 1:2182 MCCULLOCH BLVD N STE 3
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6880
Practice Address - Country:US
Practice Address - Phone:928-600-5497
Practice Address - Fax:888-276-8290
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ757435101YP2500X
AZLPC-15548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ079113Medicaid
AZ314755Medicaid