Provider Demographics
NPI:1912312240
Name:KRAMER, CARLY LAUREN (MS)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:LAUREN
Last Name:KRAMER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10040 W CHEYENNE AVE STE 170-41
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7719
Mailing Address - Country:US
Mailing Address - Phone:702-323-4050
Mailing Address - Fax:
Practice Address - Street 1:3606 N RANCHO DR
Practice Address - Street 2:SUITE 142
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3195
Practice Address - Country:US
Practice Address - Phone:702-778-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0531106H00000X
NV01513106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist