Provider Demographics
NPI:1184714750
Name:KRAMER, TERESA (PHD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:KRAMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7509 CANTRELL RD STE 217
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-2500
Mailing Address - Country:US
Mailing Address - Phone:501-420-2185
Mailing Address - Fax:
Practice Address - Street 1:7509 CANTRELL RD STE 217
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-2500
Practice Address - Country:US
Practice Address - Phone:501-420-2185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR97-9P103T00000X
AR97-09P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145534019Medicaid