Provider Demographics
NPI:1205385747
Name:CRAIG, MISTY
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1858 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-3410
Mailing Address - Country:US
Mailing Address - Phone:509-999-5657
Mailing Address - Fax:509-214-6400
Practice Address - Street 1:1858 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-3410
Practice Address - Country:US
Practice Address - Phone:509-999-5657
Practice Address - Fax:509-214-6400
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician