Provider Demographics
NPI:1003390196
Name:CRAGG, JONNY ANDREW (MA LMHCA)
Entity Type:Individual
Prefix:
First Name:JONNY
Middle Name:ANDREW
Last Name:CRAGG
Suffix:
Gender:M
Credentials:MA LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13730 15TH AVE NE APT G202
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-8415
Mailing Address - Country:US
Mailing Address - Phone:191-743-4085
Mailing Address - Fax:
Practice Address - Street 1:1400 112TH AVE SE STE 202
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6901
Practice Address - Country:US
Practice Address - Phone:917-434-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60886510101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health