Provider Demographics
NPI:1023044567
Name:CRAWFORD, PHYLLIS A
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:A
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83703
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85071-3703
Mailing Address - Country:US
Mailing Address - Phone:602-689-5012
Mailing Address - Fax:602-714-5051
Practice Address - Street 1:1480 EAST BETHANY HOME ROAD SUITE 230
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-7204
Practice Address - Country:US
Practice Address - Phone:602-689-5012
Practice Address - Fax:602-714-5051
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 1687101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health