Provider Demographics
NPI:1316009954
Name:CRAGGS, MAYNA C (MED LCPC)
Entity Type:Individual
Prefix:MS
First Name:MAYNA
Middle Name:C
Last Name:CRAGGS
Suffix:
Gender:F
Credentials:MED LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 WEST 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960
Mailing Address - Country:US
Mailing Address - Phone:618-524-9368
Mailing Address - Fax:618-524-9551
Practice Address - Street 1:206 WEST 5TH STREET
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960
Practice Address - Country:US
Practice Address - Phone:618-524-9368
Practice Address - Fax:618-524-9551
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0006415003OtherBCBS
289898OtherMHN
161815OtherVALUE OPTIONS
AS8226120001OtherCIGNA