Provider Demographics
NPI:1063841856
Name:CRAMER, JOHN PRESTON (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PRESTON
Last Name:CRAMER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N BENJAMIN LN STE 201
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5094
Mailing Address - Country:US
Mailing Address - Phone:208-287-5600
Mailing Address - Fax:208-287-5609
Practice Address - Street 1:400 N BENJAMIN LN STE 201
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5094
Practice Address - Country:US
Practice Address - Phone:208-287-5600
Practice Address - Fax:208-287-5609
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5447101Y00000X
IDLCPC-7041101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1285767574Medicaid