Provider Demographics
NPI:1639223290
Name:MCCRAW, MEKISHA TENEEL (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MEKISHA
Middle Name:TENEEL
Last Name:MCCRAW
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:9296 SAVANNA DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3241
Mailing Address - Country:US
Mailing Address - Phone:318-688-7552
Mailing Address - Fax:318-688-7552
Practice Address - Street 1:1310 N HEARNE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-6516
Practice Address - Country:US
Practice Address - Phone:318-676-5111
Practice Address - Fax:318-676-5077
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA54031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical