Basic Information
Provider Information
NPI: 1811577703
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CRAWFORD
FirstName: KATELYN
MiddleName: NICOLE
NamePrefix:  
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7951 COLLIN MCKINNEY PKWY STE 200
Address2:  
City: MCKINNEY
State: TX
PostalCode: 750707843
CountryCode: US
TelephoneNumber: 4692949075
FaxNumber:  
Practice Location
Address1: 7951 COLLIN MCKINNEY PKWY STE 200
Address2:  
City: MCKINNEY
State: TX
PostalCode: 750707843
CountryCode: US
TelephoneNumber: 4692949075
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/13/2021
LastUpdateDate: 04/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X81481TXY193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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