Provider Demographics
NPI:1659944684
Name:MCCRARY, MICHAEL (MED)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCCRARY
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2729 RAINY MEADOWS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-4422
Mailing Address - Country:US
Mailing Address - Phone:602-882-6138
Mailing Address - Fax:
Practice Address - Street 1:2729 RAINY MEADOWS AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-4422
Practice Address - Country:US
Practice Address - Phone:602-882-6138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP5019-R101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
BBH-LCPC-LIC-48607OtherLCPC
NVCP5019-ROtherCLINICAL PROFESSIONAL COUNSEOR