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NPI Code Detail

MEDICARE: NATHAN CRAGO LICDC

MEDICARE: NATHAN CRAGO LICDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor131160-2OH

General Provider Information

NPI Number : 1730592924
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN CRAGO LICDC
Provider Business Mailing Address
First Line : 2960 W ENON RD
Second Line :
City : XENIA
State : OH
Zip : 45385-8548
Country : US
Telephone Number : 937-272-4925
Fax Number :
Provider Business Practice Location Address
First Line : 2960 W ENON RD
Second Line :
City : XENIA
State : OH
Zip : 45385-8548
Country : US
Telephone Number : 937-272-4925
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2014
Last Update Date : 09/11/2025

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Directions to “ NATHAN CRAGO LICDC” Practice Location

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