Provider Demographics
NPI:1740002450
Name:PRATHER, MICHAEL D (CADAC IV)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:PRATHER
Suffix:
Gender:M
Credentials:CADAC IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7313 BRADBURY AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46809-2733
Mailing Address - Country:US
Mailing Address - Phone:260-267-2466
Mailing Address - Fax:
Practice Address - Street 1:3423 S LAFOUNTAIN ST STE C
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3857
Practice Address - Country:US
Practice Address - Phone:765-598-4947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)