Provider Demographics
NPI:1720461403
Name:KRAGER, EDWARD L (LMFT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:L
Last Name:KRAGER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-1312
Mailing Address - Country:US
Mailing Address - Phone:209-271-3595
Mailing Address - Fax:
Practice Address - Street 1:510 S FAIRMONT AVE STE 1
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3800
Practice Address - Country:US
Practice Address - Phone:209-271-3595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty