Provider Demographics
NPI:1568001915
Name:MEGHAN CRAWFORD, PSYD, LLC
Entity Type:Organization
Organization Name:MEGHAN CRAWFORD, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:626-888-1463
Mailing Address - Street 1:19300 MOLALLA AVE UNIT 515
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-0815
Mailing Address - Country:US
Mailing Address - Phone:626-888-1463
Mailing Address - Fax:503-974-0936
Practice Address - Street 1:702 JOHN ADAMS ST UNIT A
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1955
Practice Address - Country:US
Practice Address - Phone:626-888-1463
Practice Address - Fax:503-974-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500721557Medicaid