Provider Demographics
NPI:1922557511
Name:CRAWFORD, TAMELL C (LCPC)
Entity Type:Individual
Prefix:
First Name:TAMELL
Middle Name:C
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 N BROADWAY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2894
Mailing Address - Country:US
Mailing Address - Phone:316-518-1069
Mailing Address - Fax:866-950-2814
Practice Address - Street 1:1037 W MUNNELL ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-4542
Practice Address - Country:US
Practice Address - Phone:316-518-1069
Practice Address - Fax:316-330-6525
Is Sole Proprietor?:No
Enumeration Date:2016-09-24
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03506101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional