Provider Demographics
NPI:1609444942
Name:CRAWFORD, ISAAC (LPC)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 E UNIVERSITY ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2062
Mailing Address - Country:US
Mailing Address - Phone:417-496-6006
Mailing Address - Fax:
Practice Address - Street 1:1630 S ENTERPRISE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1800
Practice Address - Country:US
Practice Address - Phone:417-501-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020043286101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty