Provider Demographics
NPI:1003330630
Name:CRAFT, JODI M (MA)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:M
Last Name:CRAFT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CREEKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:PEVELY
Mailing Address - State:MO
Mailing Address - Zip Code:63070-2985
Mailing Address - Country:US
Mailing Address - Phone:636-232-1558
Mailing Address - Fax:
Practice Address - Street 1:925 CREEKVIEW CT
Practice Address - Street 2:
Practice Address - City:PEVELY
Practice Address - State:MO
Practice Address - Zip Code:63070-2985
Practice Address - Country:US
Practice Address - Phone:636-232-1558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MO2015032006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor