Provider Demographics
NPI:1043750672
Name:CRAM, PEYTON NICOLE (LPCC, LPC, LCDC III)
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:NICOLE
Last Name:CRAM
Suffix:
Gender:F
Credentials:LPCC, LPC, LCDC III
Other - Prefix:
Other - First Name:MARNIE
Other - Middle Name:NICOLE
Other - Last Name:CRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4730
Mailing Address - Country:US
Mailing Address - Phone:303-208-9368
Mailing Address - Fax:
Practice Address - Street 1:1578 MEDFORD AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1024
Practice Address - Country:US
Practice Address - Phone:303-208-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1500707101Y00000X
OHLCDCIII.161766101YA0400X
PAPC012987101YM0800X
OHE.2102280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0344350Medicaid