Provider Demographics
NPI:1740837640
Name:KRAMER, MICHAEL DIEDERICH (MS, NCC, LPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DIEDERICH
Last Name:KRAMER
Suffix:
Gender:M
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 LAMAR AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3299
Mailing Address - Country:US
Mailing Address - Phone:913-826-4200
Mailing Address - Fax:
Practice Address - Street 1:5000 W 95TH ST STE 285
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-3363
Practice Address - Country:US
Practice Address - Phone:913-748-9169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-25
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3438101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional