Provider Demographics
NPI:1205138260
Name:CRAFTON, ANDREA L (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:CRAFTON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12810 FOXWOOD PT
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-7736
Mailing Address - Country:US
Mailing Address - Phone:573-450-7550
Mailing Address - Fax:
Practice Address - Street 1:4809 WEST BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-8939
Practice Address - Country:US
Practice Address - Phone:573-450-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010040064101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional