MEDICARE: MICHAEL D MCCRARY LSCSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2080	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30854034	OTHER		BCBS OF KC

General Provider Information

NPI Number	:	1952410151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D MCCRARY LSCSW

Provider Business Mailing Address
First Line	:	6000 LAMAR AVE
Second Line	:	STE 130
City	:	MISSION
State	:	KS
Zip	:	66202-3234
Country	:	US
Telephone Number	:	913-831-2550
Fax Number	:	913-826-1589

Provider Business Practice Location Address
First Line	:	15118 GLENWOOD AVE
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66223-3338
Country	:	US
Telephone Number	:	913-715-7950
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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