MEDICARE: MR. K. CRAIG MARGO LPC, LADC, MAC, CCMH

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	40	OK
2	101YP2500X	Professional Counselor	1023	OK

General Provider Information

NPI Number	:	1962649699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. K. CRAIG MARGO LPC, LADC, MAC, CCMH

Provider Business Mailing Address
First Line	:	6608 N WESTERN AVE # 225
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7326
Country	:	US
Telephone Number	:	405-241-9151
Fax Number	:

Provider Business Practice Location Address
First Line	:	6608 N WESTERN AVE # 225
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7326
Country	:	US
Telephone Number	:	405-241-9151
Fax Number	:

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

Provider Enumeration Date	:	01/16/2009
Last Update Date	:	11/14/2010

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