Provider Demographics
NPI:1346327962
Name:MCCRACKEN, JOANN LEE (THD, LPC)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:LEE
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:THD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 S OLD HIGHWAY 94
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5612
Mailing Address - Country:US
Mailing Address - Phone:636-744-9397
Mailing Address - Fax:636-447-8174
Practice Address - Street 1:2536 S OLD HIGHWAY 94
Practice Address - Street 2:SUITE 108
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5612
Practice Address - Country:US
Practice Address - Phone:636-744-9397
Practice Address - Fax:636-447-8174
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS002172101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
42992OtherNATIONAL BOARD FOR CERTIFIED COUNSELORS (NBCC)