Provider Demographics
NPI:1568841898
Name:CRAWFORD, NATHAN JR
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:CRAWFORD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8942 PIENZA PT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-9760
Mailing Address - Country:US
Mailing Address - Phone:405-778-9392
Mailing Address - Fax:
Practice Address - Street 1:8942 PIENZA PT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-9760
Practice Address - Country:US
Practice Address - Phone:405-778-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst