Mycraco LLC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

2010024663 Issued in MO

Legal business name

MYCRACO LLC

Practice address

2053 S Waverly Ave
Springfield, MO 65804-2414

Phone

(417) 315-4962

Fax

(888) 884-4101

NPI assigned

Sep 22, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Craig Patrick Coenen, DRNPI 1821137159

Title

Ceo

Phone

(417) 315-4962

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MyCraCo LLC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Craig Patrick Coenen, PSYD

  • Clinical Psychologist
  • Springfield, MO
  • NPI 1821137159
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474502400000",
    "number": "1124577986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1238 TYLER LN",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "657148368",
            "telephone_number": "417-315-4962",
            "fax_number": "888-884-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2053 S WAVERLY AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042414",
            "telephone_number": "417-315-4962",
            "fax_number": "888-884-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYCRACO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-22",
        "last_updated": "2016-09-22",
        "status": "A",
        "authorized_official_last_name": "COENEN",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "417-315-4962",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DR"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "MO",
            "license": "2010024663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821137159",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MyCraCo LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brenda Lou Mutert, LAT ATC
• Jepchirchir Mutwol
• Steven Musili Mwanzia, CRNA
• My Healthy Kids Inc
• My World ABA LLC
• Donald W. Myears, MD
• Kyli Ann Myears, FNP
• Allyssa Myers, OTR/L
• Arianna M Myers
• Darren E Myers, MS, LPC

• Counselor in Springfield, MO
• Providers in Springfield, MO by specialty
• Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.