Provider Demographics
NPI:1902036247
Name:CRAWFORD-THOMPSON, EMILY B (PHD, LP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:B
Last Name:CRAWFORD-THOMPSON
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 N PROVIDENCE RD STE 327
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3710
Mailing Address - Country:US
Mailing Address - Phone:573-818-7010
Mailing Address - Fax:573-818-7012
Practice Address - Street 1:3401 BERRYWOOD DR STE 203
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6515
Practice Address - Country:US
Practice Address - Phone:573-777-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008034836101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494512601Medicaid