Provider Demographics
NPI:1679875322
Name:CRAWFORD, SHANNAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHANNAN
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 KELLER PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3760
Mailing Address - Country:US
Mailing Address - Phone:817-601-5540
Mailing Address - Fax:
Practice Address - Street 1:1664 KELLER PKWY STE 103
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3760
Practice Address - Country:US
Practice Address - Phone:817-601-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34887103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical