Organization
DR. KRACKE AND ASSOCIATES P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN R. KRACKE PH.D. (PRESIDENT)
(208) 743-4680
Entity
Organization
Contact information
Practice address
422 17TH ST, LEWISTON, ID 83501-2526
(208) 743-4680
(208) 743-1756
Mailing address
PO BOX 2145, LEWISTON, ID 83501-1465
(208) 743-4680
(208) 743-1756
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
PSY189
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015963
REGENCE BLUESHIELD OF IDA
ID
01
—
N4478
BLUE CROSS OF IDAHO
ID
Enumeration date
01/04/2007
Last updated
08/22/2020
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