Individual
MICHAEL TODD KRAGT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1515 FORTINO BLVD, SUITE 120, PUEBLO, CO 81008-1664
(719) 544-4111
(719) 544-3497
Mailing address
1515 FORTINO BLVD, SUITE 120, PUEBLO, CO 81008-1664
(719) 544-4111
(719) 544-3497
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
5177
CO
103TC0700X
Clinical Psychologist
2188
CO
Other
Enumeration date
07/05/2012
Last updated
07/05/2012
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