Provider Demographics
NPI:1861722308
Name:CRAWFORD, BERNADINE O (LPCC)
Entity type:Individual
Prefix:MRS
First Name:BERNADINE
Middle Name:O
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 DYER ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4802
Mailing Address - Country:US
Mailing Address - Phone:575-532-9628
Mailing Address - Fax:575-532-9628
Practice Address - Street 1:880 ANTHONY DR
Practice Address - Street 2:SUITE 3B
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-9346
Practice Address - Country:US
Practice Address - Phone:575-882-5290
Practice Address - Fax:575-882-1879
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4079101YM0800X
TX11860101YM0800X
NM285834101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool