Provider Demographics
NPI:1366528622
Name:MCCRACKEN, JOE WARREN (MED, LPC)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:WARREN
Last Name:MCCRACKEN
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 N. UNIVERSITY
Mailing Address - Street 2:#D2
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4247
Mailing Address - Country:US
Mailing Address - Phone:936-564-7310
Mailing Address - Fax:936-564-7810
Practice Address - Street 1:1329 N. UNIVERSITY
Practice Address - Street 2:#D2
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4247
Practice Address - Country:US
Practice Address - Phone:936-564-7310
Practice Address - Fax:936-564-7810
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health