Provider Demographics
NPI:1801348032
Name:CRAGER, KELLEN
Entity type:Individual
Prefix:
First Name:KELLEN
Middle Name:
Last Name:CRAGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 S PARKER RD STE 185
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1626
Mailing Address - Country:US
Mailing Address - Phone:720-347-8559
Mailing Address - Fax:606-329-8195
Practice Address - Street 1:2620 S PARKER RD STE 185
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1626
Practice Address - Country:US
Practice Address - Phone:720-347-8559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 390200000X
KY174349101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor