Provider Demographics
NPI:1508449489
Name:CROMER, KELLY DIANE
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:DIANE
Last Name:CROMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 S MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5361
Mailing Address - Country:US
Mailing Address - Phone:305-495-6944
Mailing Address - Fax:
Practice Address - Street 1:6105 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5361
Practice Address - Country:US
Practice Address - Phone:305-495-6944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11052103TC0700X
COPSY.0005543103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical