Provider Demographics
NPI:1093226904
Name:KRAFT, MEGAN A (LPC, LPCC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:KRAFT
Suffix:
Gender:F
Credentials:LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 COBBLESTONE LOOP SW
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-8541
Mailing Address - Country:US
Mailing Address - Phone:701-290-7144
Mailing Address - Fax:
Practice Address - Street 1:1400 43RD AVE NE STE 260
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-6193
Practice Address - Country:US
Practice Address - Phone:701-955-8283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND820-2-1-15101YP2500X
ND820-2-1-15-306101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1472863Medicaid