Provider Demographics
NPI:1083083018
Name:MCCRAY, SHANTAI (PLPC)
Entity Type:Individual
Prefix:
First Name:SHANTAI
Middle Name:
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8118 WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-2200
Mailing Address - Country:US
Mailing Address - Phone:816-668-8289
Mailing Address - Fax:
Practice Address - Street 1:2420 E. LINWOOD BLVD
Practice Address - Street 2:SUITE 300 C
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109
Practice Address - Country:US
Practice Address - Phone:816-881-6509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015028459101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor