Provider Demographics
NPI:1447775879
Name:CRAWFORD, CLINT (MA, MPC)
Entity Type:Individual
Prefix:MR
First Name:CLINT
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:MA, MPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 S EASON BLVD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-6942
Mailing Address - Country:US
Mailing Address - Phone:662-504-4382
Mailing Address - Fax:662-680-6416
Practice Address - Street 1:920 BOONE ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-5908
Practice Address - Country:US
Practice Address - Phone:662-504-4382
Practice Address - Fax:662-680-6416
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)