Provider Demographics
NPI:1457505182
Name:CRAIN, MICHAEL W
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:CRAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FLAGG PL STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7063
Mailing Address - Country:US
Mailing Address - Phone:337-216-9800
Mailing Address - Fax:
Practice Address - Street 1:6 FLAGG PL STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7063
Practice Address - Country:US
Practice Address - Phone:337-216-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA402101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional