Provider Demographics
NPI:1790116648
Name:CRAWFORD, MICHELLE (LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6607 BRODIE LN APT 523
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1033 LA POSADA DR
Practice Address - Street 2:374
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3842
Practice Address - Country:US
Practice Address - Phone:512-961-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67859101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional