| Mycraco Llc | |
|
2053 S Waverly Ave Springfield MO 65804-2414 | |
| (417) 315-4962 | |
| (888) 884-4101 |
| Full Name | Mycraco Llc |
|---|---|
| Speciality | Counselor |
| Location | 2053 S Waverly Ave, Springfield, Missouri |
| Authorized Official Name and Position | Craig Patrick Coenen (CEO) |
| Authorized Official Contact | 4173154962 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mycraco Llc 1238 Tyler Ln Nixa MO 65714-8368 Ph: (417) 315-4962 | Mycraco Llc 2053 S Waverly Ave Springfield MO 65804-2414 Ph: (417) 315-4962 |
| NPI Number | 1124577986 |
|---|---|
| Provider Enumeration Date | 09/22/2016 |
| Last Update Date | 09/22/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124577986 | NPI | - | NPPES |
| 1821137159 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 2010024663 (Missouri) | Primary |
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