1265705362 NPI number — JENNA WILSON CRAWLEY LPC, LCAS

Table of content: JENNA WILSON CRAWLEY LPC, LCAS (NPI 1265705362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265705362 NPI number — JENNA WILSON CRAWLEY LPC, LCAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAWLEY
Provider First Name:
JENNA
Provider Middle Name:
WILSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, LCAS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265705362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
681 SLEEPY HOLLOW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANNER ELK
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28604-9703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-260-6418
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 STATE FARM RD
Provider Second Line Business Practice Location Address:
304
Provider Business Practice Location Address City Name:
BOONE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28607-4914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-260-6419
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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