Provider Demographics
NPI:1154168912
Name:CRAFT, MARCEL I
Entity type:Individual
Prefix:MR
First Name:MARCEL
Middle Name:
Last Name:CRAFT
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 SOFT WATER LAKE DR NE APT 203
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-2734
Mailing Address - Country:US
Mailing Address - Phone:616-706-1997
Mailing Address - Fax:
Practice Address - Street 1:1260 EKHART ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1380
Practice Address - Country:US
Practice Address - Phone:616-965-3492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician