1407174360 NPI number — MRS. AMANDA OLIVER CRAWN LPC, NCC

Table of content: MRS. AMANDA OLIVER CRAWN LPC, NCC (NPI 1407174360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407174360 NPI number — MRS. AMANDA OLIVER CRAWN LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAWN
Provider First Name:
AMANDA
Provider Middle Name:
OLIVER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLIVER
Provider Other First Name:
AMANDA
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407174360
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
746 S JERSEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80224-1415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-617-2746
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 N BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-293-2220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2010

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: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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