Individual
CARRIE CROCKFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
25526 189TH ST NW, BIG LAKE, MN 55309-4509
(612) 306-4328
Mailing address
PO BOX 833, BIG LAKE, MN 55309
(612) 306-4328
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
3233
MN
Other
Enumeration date
11/21/2017
Last updated
11/21/2017
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