Craig Patrick Coenen, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2016035928 Issued in MO

Practice address

2053 S Waverly Ave Ste D
Springfield, MO 65804-2497

Phone

(417) 315-4962

Fax

(888) 884-4101

NPI assigned

Feb 5, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mycraco LLC

  • Counselor
  • Springfield, MO
  • NPI 1124577986
  NPD Authorized official
• Integrative Family Psychology

  • Psychologist
  • Springfield, MO
  • NPI 1023565348
  NPD (past)

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508112000000",
    "number": "1821137159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2053 S WAVERLY AVE SUITE D",
            "address_2": "#101",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658071497",
            "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 STE D",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042497",
            "telephone_number": "417-315-4962",
            "fax_number": "888-884-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COENEN",
        "first_name": "CRAIG",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2017-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2010024663",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2016035928",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "499955409",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melvin L Cochran, MD
• Tom Cochran
• Todd Codemo, PHARMD
• Kimberly R. Coder, FNP
• Jennifer L Codutti, ATC
• Ashley L Coffer, COTA/L
• Megan Marie Coffman, ATC
• Brenton Raval Coger, M.D.
• Cognivantage, LLC
• Patricia E Cogswell, LPC

• Clinical Psychologist in Springfield, MO
• Providers in Springfield, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.