Provider Demographics
NPI:1821273442
Name:KERN, CRAIG (MA LPC-S, LMFT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:KERN
Suffix:
Gender:M
Credentials:MA LPC-S, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8913 COLLINFIELD DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-6704
Mailing Address - Country:US
Mailing Address - Phone:512-324-6878
Mailing Address - Fax:
Practice Address - Street 1:8913 COLLINFIELD DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6704
Practice Address - Country:US
Practice Address - Phone:512-324-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63559101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220008101Medicaid