Provider Demographics
NPI:1780399592
Name:CRAWFORD, KELLY MARGRET (LLPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARGRET
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2769
Mailing Address - Country:US
Mailing Address - Phone:718-637-9456
Mailing Address - Fax:
Practice Address - Street 1:955 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2769
Practice Address - Country:US
Practice Address - Phone:718-637-9456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
MI6451022934101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171400000XOther Service ProvidersHealth & Wellness Coach