Provider Demographics
NPI:1770876963
Name:CRAWFORD COUNSELING GROUP
Entity type:Organization
Organization Name:CRAWFORD COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-424-9433
Mailing Address - Street 1:2530 CRAWFORD AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4972
Mailing Address - Country:US
Mailing Address - Phone:847-424-9433
Mailing Address - Fax:847-869-8116
Practice Address - Street 1:2530 CRAWFORD AVE STE 304
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4972
Practice Address - Country:US
Practice Address - Phone:847-424-9433
Practice Address - Fax:847-869-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962482471OtherINDIVIDUAL NPI