Basic Information
| Provider Information | |||||||||
| NPI: | 1215310339 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAWFORD | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3440 TORRANCE BLVD STE 104 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905035805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107871335 | ||||||||
| FaxNumber: | 3107871809 | ||||||||
| Practice Location | |||||||||
| Address1: | 3440 TORRANCE BLVD STE 104 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905035805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107871335 | ||||||||
| FaxNumber: | 3107871809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2015 | ||||||||
| LastUpdateDate: | 05/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.