Provider Demographics
NPI:1740618834
Name:CRANMER, JESSICCA N (MED, LPCC)
Entity Type:Individual
Prefix:
First Name:JESSICCA
Middle Name:N
Last Name:CRANMER
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-1367
Mailing Address - Country:US
Mailing Address - Phone:270-801-7233
Mailing Address - Fax:270-352-3467
Practice Address - Street 1:100 GRAY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2608
Practice Address - Country:US
Practice Address - Phone:270-360-4719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1884101YM0800X
KY390200000X
KY252408101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program