Provider Demographics
NPI:1982782116
Name:CRAWFORD, DAN (MFTI)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:MFTI
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 593
Mailing Address - Street 2:
Mailing Address - City:NORTH SAN JUAN
Mailing Address - State:CA
Mailing Address - Zip Code:95960-0593
Mailing Address - Country:US
Mailing Address - Phone:530-559-8882
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:530-559-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84869106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist