Provider Demographics
NPI:1922366111
Name:CRAIG, ELBERT NATHANIEL JR
Entity Type:Individual
Prefix:
First Name:ELBERT
Middle Name:NATHANIEL
Last Name:CRAIG
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NE 46TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-3309
Mailing Address - Country:US
Mailing Address - Phone:405-602-6331
Mailing Address - Fax:
Practice Address - Street 1:401 NE 46TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-3309
Practice Address - Country:US
Practice Address - Phone:405-602-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor