Provider Demographics
NPI:1669577961
Name:CRAWFORD, STEPHANIE JILL (MS)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JILL
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 COUNTY ROAD 54
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-5118
Mailing Address - Country:US
Mailing Address - Phone:662-473-1571
Mailing Address - Fax:
Practice Address - Street 1:967 REGIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-3551
Practice Address - Country:US
Practice Address - Phone:662-234-1476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health