Provider Demographics
NPI:1730490947
Name:CRANE, CHRISTY FAITH (MA)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTY
Middle Name:FAITH
Last Name:CRANE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 CRAIG RD
Mailing Address - Street 2:STE. 304
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7160
Mailing Address - Country:US
Mailing Address - Phone:314-983-9300
Mailing Address - Fax:314-983-9308
Practice Address - Street 1:745 CRAIG RD
Practice Address - Street 2:STE. 304
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7160
Practice Address - Country:US
Practice Address - Phone:314-983-9300
Practice Address - Fax:314-983-9308
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012040742101Y00000X
MO2012041376106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist