Provider Demographics
NPI:1356470082
Name:KRAEMER, STACEY FORDHAM (LPC)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:FORDHAM
Last Name:KRAEMER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15522 FOUR LEAF DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3663
Mailing Address - Country:US
Mailing Address - Phone:281-463-7698
Mailing Address - Fax:
Practice Address - Street 1:6823 CYPRESSWOOD DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7705
Practice Address - Country:US
Practice Address - Phone:281-376-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional