Provider Demographics
NPI:1629412523
Name:CRAWFORD, REBECCA ANN (BSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:124 S BROADWAY AVE STE 409
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-5807
Mailing Address - Country:US
Mailing Address - Phone:580-332-8773
Mailing Address - Fax:580-332-8774
Practice Address - Street 1:124 S BROADWAY AVE STE 409
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5807
Practice Address - Country:US
Practice Address - Phone:580-332-8773
Practice Address - Fax:580-332-8774
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)