Provider Demographics
NPI:1689879397
Name:MCCRATIC, MICHAEL (MFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCCRATIC
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1943
Mailing Address - Street 2:
Mailing Address - City:MURPHYS
Mailing Address - State:CA
Mailing Address - Zip Code:95247-1943
Mailing Address - Country:US
Mailing Address - Phone:209-728-9118
Mailing Address - Fax:
Practice Address - Street 1:225 SPRING ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6625
Practice Address - Country:US
Practice Address - Phone:925-846-7768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25679106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist