Provider Demographics
NPI:1821130303
Name:MCCRACKEN, JERRY LYNN (MS,LPC)
Entity Type:Individual
Prefix:MRS
First Name:JERRY
Middle Name:LYNN
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:MS,LPC
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:MCCRACKEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:313 SHADY HILL DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1943
Mailing Address - Country:US
Mailing Address - Phone:972-480-0779
Mailing Address - Fax:
Practice Address - Street 1:100 N CENTRAL EXPY STE 614
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5323
Practice Address - Country:US
Practice Address - Phone:972-889-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62618101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional