Provider Demographics
NPI:1952935942
Name:ONE22 CRAFT ADVISORS CORPORATION
Entity type:Organization
Organization Name:ONE22 CRAFT ADVISORS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONTAVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:214-566-9833
Mailing Address - Street 1:2824 GOOSEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-2044
Mailing Address - Country:US
Mailing Address - Phone:214-566-9833
Mailing Address - Fax:
Practice Address - Street 1:626 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4619
Practice Address - Country:US
Practice Address - Phone:214-566-9833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251B00000XAgenciesCase Management
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LABH0011581Medicaid