Provider Demographics
NPI:1770905424
Name:CRAYTOR, MICHAEL (PSYD, LPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CRAYTOR
Suffix:
Gender:M
Credentials:PSYD, LPC
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 1873
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-1873
Mailing Address - Country:US
Mailing Address - Phone:907-422-0606
Mailing Address - Fax:
Practice Address - Street 1:234 FOURTH AVE STE 107
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664-4210
Practice Address - Country:US
Practice Address - Phone:907-422-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK114233101YP2500X
AK210447103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist