Basic Information
| Provider Information | |||||||||
| NPI: | 1194901637 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRANE | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 365 W 50 N STE W8 | ||||||||
| Address2: | |||||||||
| City: | VERNAL | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840782010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357902757 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 365 W 50 N STE W8 | ||||||||
| Address2: | |||||||||
| City: | VERNAL | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840782010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357902757 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2008 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 6845102-3902 | UT | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.