Healthcare Provider Details

I. General information

NPI: 1629117478
Provider Name (Legal Business Name): JAY C CRAMER MS LMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E 23RD ST STE 204
FREMONT NE
68025-2300
US

IV. Provider business mailing address

3341 S 113TH ST
OMAHA NE
68144-4741
US

V. Phone/Fax

Practice location:
  • Phone: 402-721-1417
  • Fax:
Mailing address:
  • Phone: 402-721-1417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2069
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: