MEDICARE: KENSHARA MARIE CRAVENS LMSW, CCM, LCDC(CI)

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101Y00000X	Counselor
3	104100000X	Social Worker
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1417558115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENSHARA MARIE CRAVENS LMSW, CCM, LCDC(CI)

Provider Business Mailing Address
First Line	:	7825 DIAMOND OAK DR
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-2545
Country	:	US
Telephone Number	:	832-297-1131
Fax Number	:

Provider Business Practice Location Address
First Line	:	7825 DIAMOND OAK DR
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-2545
Country	:	US
Telephone Number	:	832-297-1131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2020
Last Update Date	:	11/08/2020

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