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General NPI Number Information
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NPI Number | 1598307969
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Entity Type | Organization
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Legal Business Name | EDWARD LESTER KRAGER
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Dates
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Enumeration Date | 10/17/2019
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 510 S FAIRMONT AVE STE 1
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City | LODI
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State | CA
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Zip | 95240-3800
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Country | US
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Telephone | 209-271-3595
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Fax |
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Provider Business Mailing Address
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Address Line | 2617 BIRCH AVE
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City | STOCKTON
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State | CA
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Zip | 95207-1312
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Country | US
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Telephone | 209-271-3595
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EDWARD KRAGER
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Credential | LMFT
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Telephone | 209-271-3595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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