Provider Demographics
NPI:1881706216
Name:CRAWFORD, ELEANOR CATHERINE (MFT INTERN)
Entity type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:CATHERINE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PROVIDENCE MINE RD
Mailing Address - Street 2:SUITE 106C
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2939
Mailing Address - Country:US
Mailing Address - Phone:530-559-8902
Mailing Address - Fax:
Practice Address - Street 1:101 PROVIDENCE MINE RD
Practice Address - Street 2:106C
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2939
Practice Address - Country:US
Practice Address - Phone:530-559-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81805106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51239OtherMFTI LICENSE