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Organization
MYCRACO LLC
Active
Organization
MYCRACO LLC
Active
Other names
MyCraCo LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRAIG PATRICK COENEN DR (CEO)
(417) 315-4962
Entity
Organization
Contact information
Practice address
2053 S WAVERLY AVE, SPRINGFIELD, MO 65804-2414
(417) 315-4962
(888) 884-4101
Mailing address
1238 TYLER LN, NIXA, MO 65714-8368
(417) 315-4962
(888) 884-4101
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2010024663
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821137159
—
MO
Enumeration date
09/22/2016
Last updated
09/22/2016
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