Basic Information
| Provider Information | |||||||||
| NPI: | 1619131984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRANE | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | ROSS | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1208 | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814021208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702523200 | ||||||||
| FaxNumber: | 9702523208 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 W COLORADO BLVD | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | TELLURIDE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707286303 | ||||||||
| FaxNumber: | 9703691261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2008 | ||||||||
| LastUpdateDate: | 07/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2906 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.