Basic Information
| Provider Information | |||||||||
| NPI: | 1700838885 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IRELAND | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3067 | ||||||||
| Address2: | |||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773053067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365216100 | ||||||||
| FaxNumber: | 9367602898 | ||||||||
| Practice Location | |||||||||
| Address1: | 1020 RIVERWOOD CT | ||||||||
| Address2: | |||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773042811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365216100 | ||||||||
| FaxNumber: | 9367602898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | S13627 | TX | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8332BH | 01 | TX | BCBS OF TX | OTHER |