Provider Demographics
NPI:1871568410
Name:CRANE, DAVID L (LPCC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:CRANE
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E HIGH ST
Mailing Address - Street 2:P.O. BOX 881
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-2726
Mailing Address - Country:US
Mailing Address - Phone:505-461-6200
Mailing Address - Fax:505-461-0404
Practice Address - Street 1:102 E HIGH ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2726
Practice Address - Country:US
Practice Address - Phone:505-461-6200
Practice Address - Fax:505-461-0404
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM006177101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM100178OtherINDIV PROV MEDICAID
NM43220380Medicaid