Provider Demographics
NPI:1376877332
Name:MEYERS MCCRACKEN, KATHREN ANN (RN, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHREN
Middle Name:ANN
Last Name:MEYERS MCCRACKEN
Suffix:
Gender:F
Credentials:RN, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3452
Mailing Address - Country:US
Mailing Address - Phone:530-343-9531
Mailing Address - Fax:
Practice Address - Street 1:478 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3452
Practice Address - Country:US
Practice Address - Phone:530-343-9531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 136871041C0700X
CA284029163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult