Provider Demographics
NPI:1538217906
Name:CRAWFORD, ELLEN L (PHD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:H-149
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-1217
Mailing Address - Country:US
Mailing Address - Phone:859-323-5000
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:H-149
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-1217
Practice Address - Country:US
Practice Address - Phone:859-323-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY130454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KYP14088Medicare UPIN
KY0331417Medicare ID - Type UnspecifiedMEDICARE
KY0331215Medicare ID - Type UnspecifiedMEDICARE
KY0331711Medicare ID - Type UnspecifiedMEDICARE
KY3314Medicare ID - Type UnspecifiedMEDICARE