Individual
MR. JEFFERSON H KRACZEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4433 BEVERLAND ROAD, MACKAY, ID 83251-8048
(208) 588-2770
(208) 588-2984
Mailing address
PO BOX 402, MACKAY, ID 83251-0402
(208) 588-2770
(208) 588-2984
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW27821
ID
Other
Enumeration date
02/07/2012
Last updated
06/21/2021
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