Provider Demographics
NPI:1407442361
Name:CRAWFORD, MYIA ELIZABETH WHITECLOUD
Entity Type:Individual
Prefix:
First Name:MYIA ELIZABETH
Middle Name:WHITECLOUD
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5037 21ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3330
Mailing Address - Country:US
Mailing Address - Phone:909-212-9966
Mailing Address - Fax:
Practice Address - Street 1:5037 21ST AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3330
Practice Address - Country:US
Practice Address - Phone:909-212-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANAMedicaid