Individual provider Active NPI

Walter Lee Crawford, LPC

  • Professional Counselor
  • Jonesboro, AR
National Provider Identifier
1376586297
Registry record updated May 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
P9401004 Issued in AR
Practice address
1815 Pleasant Grove Rd
Jonesboro, AR 72401
Phone
(870) 933-6886
Fax
(870) 933-9395
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Professional Counselor 101YP2500X AR
Professional Counselor 101YP2500X P9401004 AR Primary

Addresses

Primary practice location

1815 Pleasant Grove Rd
Jonesboro, AR 72401

Mailing address

1815 Pleasant Grove Rd
Jonesboro, AR 72401-7870
Phone (870) 933-6886

Other identifiers 3

IdentifierTypeStateIssuer
5X977OtherARBCBS
169856795MedicaidAR
5X977OtherARBLUE CROSS NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240206002760 AR Practitioner - Mental Health Counselor 9830547603 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P9401004ARMDPsychiatric/Mental Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Families, Inc of Arkansas Mental Health CurrentSince Jan 1, 2024 Accepting new patients

Locations

1815 Pleasant Grove Rd
Jonesboro, AR 72405
Phone (870) 833-6886

1425 W Main St
Walnut Ridge, AR 72476
Phone (870) 886-5303

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526515200000",
    "number": "1376586297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 PLEASANT GROVE RD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724017870",
            "telephone_number": "870-933-6886",
            "fax_number": "870-933-9395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 PLEASANT GROVE RD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "72401",
            "telephone_number": "870-933-6886",
            "fax_number": "870-933-9395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAWFORD",
        "first_name": "WALTER",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2018-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P9401004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5X977",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "169856795",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS NUMBER",
            "identifier": "5X977",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

Verify at the official NPI Registry.