Provider Demographics
NPI:1871587386
Name:CRAWFORD, THOMAS H (LPC SAC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:H
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:LPC SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 S 76TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4364
Mailing Address - Country:US
Mailing Address - Phone:414-325-7741
Mailing Address - Fax:414-325-7753
Practice Address - Street 1:4811 S 76TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4364
Practice Address - Country:US
Practice Address - Phone:414-325-7741
Practice Address - Fax:414-325-7753
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11357101YA0400X
WI5218-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39794100OtherCENPATICO
WI39794100OtherHIRSP
2036410OtherCIGNA
253921000OtherMAGELLAN BID HEALTH
WI39794100Medicaid
2036410OtherCIGNA