Healthcare Provider Details

I. General information

NPI: 1780917245
Provider Name (Legal Business Name): CODY VAIL CRAMER LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 12/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 E 8TH ST
LIMA OH
45804-2482
US

IV. Provider business mailing address

441 E 8TH ST
LIMA OH
45804-2482
US

V. Phone/Fax

Practice location:
  • Phone: 419-221-3072
  • Fax: 419-225-8878
Mailing address:
  • Phone: 419-221-3072
  • Fax: 419-225-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1300033
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: