Provider Demographics
NPI:1629791165
Name:CRAWFORD, NICOLE ELISE (PLMHP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ELISE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:ELISE CRAWFORD
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLMHP
Mailing Address - Street 1:6107 MAPLE ST STE B
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-4001
Mailing Address - Country:US
Mailing Address - Phone:531-210-0719
Mailing Address - Fax:
Practice Address - Street 1:6107 MAPLE ST STE B
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-4001
Practice Address - Country:US
Practice Address - Phone:531-210-0719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health