Healthcare Provider Details

I. General information

NPI: 1164368692
Provider Name (Legal Business Name): GREGORY LANDON KRAFFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 LANTERN RD STE 250
FISHERS IN
46037-9408
US

IV. Provider business mailing address

10100 LANTERN RD STE 250
FISHERS IN
46037-9408
US

V. Phone/Fax

Practice location:
  • Phone: 317-992-1988
  • Fax:
Mailing address:
  • Phone: 317-992-1988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88002436A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: