Provider Demographics
NPI:1700511094
Name:MCCRACKEN, THOMAS M
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:MCCRACKEN
Suffix:
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:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:MT
Mailing Address - Zip Code:59932-0084
Mailing Address - Country:US
Mailing Address - Phone:406-564-7113
Mailing Address - Fax:
Practice Address - Street 1:1807 3RD AVE E
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5758
Practice Address - Country:US
Practice Address - Phone:406-607-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBHSWLCLIC255881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty