Healthcare Provider Details

I. General information

NPI: 1356470082
Provider Name (Legal Business Name): STACEY FORDHAM KRAEMER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6823 CYPRESSWOOD DR
SPRING TX
77379-7705
US

IV. Provider business mailing address

15522 FOUR LEAF DR
HOUSTON TX
77084-3663
US

V. Phone/Fax

Practice location:
  • Phone: 281-376-8006
  • Fax:
Mailing address:
  • Phone: 281-463-7698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20246
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: