Healthcare Provider Details

I. General information

NPI: 1437825577
Provider Name (Legal Business Name): SCOTT D. MCCRACKEN MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 W WASHINGTON ST
TEMPE AZ
85288-1697
US

IV. Provider business mailing address

PO BOX 45042
PHOENIX AZ
85064-5042
US

V. Phone/Fax

Practice location:
  • Phone: 24-710-6706
  • Fax:
Mailing address:
  • Phone: 480-565-9276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-24486
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: