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General NPI Number Information
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NPI Number | 1114817368
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Entity Type | Individual
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Provider Name | COURTNEY CRAIG
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Gender |
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 5815 BROADWAY AVE
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City | GREAT BEND
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State | KS
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Zip | 67530-3197
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Country | US
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Telephone | 620-792-2544
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Fax | 620-792-7052
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Provider Business Mailing Address
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Address Line | 5815 BROADWAY AVE
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City | GREAT BEND
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State | KS
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Zip | 67530-3197
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Country | US
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Telephone | 620-792-2544
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Fax | 620-792-7052
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 03914
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License Number State | KS
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