Provider Demographics
NPI:1447847736
Name:CRAFT, GLENDA FAYE
Entity type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:FAYE
Last Name:CRAFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:LA
Mailing Address - Zip Code:71435-3684
Mailing Address - Country:US
Mailing Address - Phone:318-235-8874
Mailing Address - Fax:
Practice Address - Street 1:401 PARKER RD
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:LA
Practice Address - Zip Code:71435-3684
Practice Address - Country:US
Practice Address - Phone:318-235-8874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst