Provider Demographics
NPI:1427712892
Name:MCCRACKEN, SARAH JANELLE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JANELLE
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JANELLE
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44199 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3096
Mailing Address - Country:US
Mailing Address - Phone:760-863-8262
Mailing Address - Fax:760-770-2240
Practice Address - Street 1:44199 MONROE ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3096
Practice Address - Country:US
Practice Address - Phone:760-863-8262
Practice Address - Fax:760-770-2240
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAR1443330921101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator