Provider Demographics
NPI:1912082942
Name:CRAFT, MICHAEL S (MA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:CRAFT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:S
Other - Last Name:CAMACHO-CRAFT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:400 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-5080
Mailing Address - Country:US
Mailing Address - Phone:805-347-0072
Mailing Address - Fax:805-348-0033
Practice Address - Street 1:400 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-5080
Practice Address - Country:US
Practice Address - Phone:805-347-0072
Practice Address - Fax:805-348-0033
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28976106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist