Provider Demographics
NPI:1811302706
Name:CRAMER, CRYSTAL (MA, MS)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:CRAMER
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 BASSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-4478
Mailing Address - Country:US
Mailing Address - Phone:732-611-0395
Mailing Address - Fax:
Practice Address - Street 1:585 BASSWOOD DR
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-4478
Practice Address - Country:US
Practice Address - Phone:573-261-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014019322101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional