Provider Demographics
NPI:1669255162
Name:CRAIG, MACY MARIE
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:MARIE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8988 S SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5051
Mailing Address - Country:US
Mailing Address - Phone:918-906-3766
Mailing Address - Fax:
Practice Address - Street 1:5330 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5076
Practice Address - Country:US
Practice Address - Phone:918-906-3766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2024-07-26
Deactivation Date:2024-07-12
Deactivation Code:
Reactivation Date:2024-07-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health