=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740618834
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICCA N CRANMER M.ED., LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2013
-----------------------------------------------------
Last Update Date | 12/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 GRAY ST
-----------------------------------------------------
City | ELIZABETHTOWN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42701-2608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-360-4719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 387 PARK AVE
-----------------------------------------------------
City | RADCLIFF
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40160-1367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-801-7233
-----------------------------------------------------
Fax | 270-352-3467
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 1884
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 252408
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------